Healthcare Provider Details

I. General information

NPI: 1093619264
Provider Name (Legal Business Name): JESSICA TROI THOMPSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W GEORGIA AVE
NAMPA ID
83686-2835
US

IV. Provider business mailing address

6424 USTICK RD
NAMPA ID
83687-8104
US

V. Phone/Fax

Practice location:
  • Phone: 208-960-7474
  • Fax:
Mailing address:
  • Phone: 208-805-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: