MEDICARE: PEPE L THOMPSON ACNP

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	363L00000X	Nurse Practitioner	8346	TN
2	363LA2100X	Acute Care Nurse Practitioner	3013387	KY
3	363LA2100X	Acute Care Nurse Practitioner	8346	TN

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
2	4271773	OTHER	TN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942299599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEPE L THOMPSON ACNP

Provider Business Mailing Address
First Line	:	127 N OAK AVE
Second Line	:	SUITE D
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2435
Country	:	US
Telephone Number	:	931-783-5857
Fax Number	:	931-526-6760

Provider Business Practice Location Address
First Line	:	145 W 4TH ST
Second Line	:	SUITE 102
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2447
Country	:	US
Telephone Number	:	931-783-2143
Fax Number	:	931-783-2152

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	10/10/2019

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