Healthcare Provider Details

I. General information

NPI: 1073815742
Provider Name (Legal Business Name): JADIE THOMPSON ABENDROTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JADIE LYNNE THOMPSON PA-C

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-7600
  • Fax:
Mailing address:
  • Phone: 901-516-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1932
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number200401
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: