Healthcare Provider Details

I. General information

NPI: 1811388739
Provider Name (Legal Business Name): JAYE RACHELLE THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MAIN ST
BRINKLEY AR
72021-2507
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-734-1150
  • Fax: 870-734-1179
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-301-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA004323
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: