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General NPI Number Information
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NPI Number | 1316388077
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Entity Type | Individual
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Provider Name | JACLYN THOMPSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 224 LEAVENWORTH RD
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City | SHELTON
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State | CT
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Zip | 06484-1881
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Country | US
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Telephone | 203-926-1206
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Fax | 203-926-0413
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Provider Business Mailing Address
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Address Line | 67 MAPLE AVE
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City | DERBY
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State | CT
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Zip | 06418-1328
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Country | US
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Telephone | 203-732-1330
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Fax | 203-732-1332
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002923
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License Number State | CT
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