Healthcare Provider Details

I. General information

NPI: 1265346456
Provider Name (Legal Business Name): JORDAN THOMPSON
Entity Type: Individual
Gender: Female
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

3341 ROBERTS RD
CHATTANOOGA TN
37416-2804
US

IV. Provider business mailing address

3341 ROBERTS RD
CHATTANOOGA TN
37416-2804
US

V. Phone/Fax

Practice location:
  • Phone: 423-598-1874
  • Fax:
Mailing address:
  • Phone: 423-598-1874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number251710
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: