MEDICARE: JANNA K THOMPSON PAC

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	363A00000X	Physician Assistant	PA1477	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942265525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNA K THOMPSON PAC

Provider Business Mailing Address
First Line	:	721 W BROADWAY AVE STE C
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3800
Country	:	US
Telephone Number	:	580-297-5340
Fax Number	:	580-297-5344

Provider Business Practice Location Address
First Line	:	721 W BROADWAY AVE STE C
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-3800
Country	:	US
Telephone Number	:	580-297-5340
Fax Number	:	580-297-5344

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	09/05/2024

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Directions to “ JANNA K THOMPSON PAC” Practice Location

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