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General NPI Number Information
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NPI Number | 1275031932
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Entity Type | Individual
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Provider Name | JESSICA L THOMSON MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 3721 FREEDOM CIRCLE BLDG 1770A
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City | NELLIS AFB
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State | NV
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Zip | 89191-8919
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Country | US
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Telephone | 702-679-2407
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Fax |
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Provider Business Mailing Address
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Address Line | 1153 CAMPASSOLE CT
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City | HENDERSON
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State | NV
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Zip | 89052-5962
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Country | US
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Telephone | 702-533-3711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0506506
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License Number State | NV
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