=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801609045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQULINE LANE THOMPSON ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2006 N 4TH ST SUITE 200
-----------------------------------------------------
City | INDIANOLA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-461-9784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 S CENTRAL AVE
-----------------------------------------------------
City | LACONA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50139-1006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-402-0477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A182650
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------