Healthcare Provider Details

I. General information

NPI: 1295139624
Provider Name (Legal Business Name): JESSI THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 W WOODMILL DR STE 35
WILMINGTON DE
19808-4068
US

IV. Provider business mailing address

5209 W WOODMILL DR STE 35
WILMINGTON DE
19808-4068
US

V. Phone/Fax

Practice location:
  • Phone: 302-762-6675
  • Fax:
Mailing address:
  • Phone: 302-762-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL1-0032609
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012127
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: