MEDICARE: MR. SAMUEL JABARY THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1013865872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL JABARY THOMPSON

Provider Business Mailing Address
First Line	:	7588 MYHAND LN
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-4539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7588 MYHAND LN
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-4539
Country	:	US
Telephone Number	:	870-250-0282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ MR. SAMUEL JABARY THOMPSON ” Practice Location

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