Provider Demographics
NPI:1033701859
Name:THOMPSON, JENNIFER ILENE (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ILENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ILENE
Other - Last Name:GOINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2225
Mailing Address - Country:US
Mailing Address - Phone:304-436-6800
Mailing Address - Fax:
Practice Address - Street 1:148 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2225
Practice Address - Country:US
Practice Address - Phone:304-436-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV69362163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice