MEDICARE: JEANNE KAY THOMPSON FNP-BC

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	363LF0000X	Family Nurse Practitioner	23029	TN

General Provider Information

NPI Number	:	1154832459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE KAY THOMPSON FNP-BC

Provider Business Mailing Address
First Line	:	137 GRACEY HTS
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-2029
Country	:	US
Telephone Number	:	931-808-4948
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 HOWELL ST
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1008
Country	:	US
Telephone Number	:	931-739-0048
Fax Number	:

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

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	10/13/2017

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