Provider Demographics
NPI:1275031932
Name:THOMSON, JESSICA L (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:THOMSON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 CAMPASSOLE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5962
Mailing Address - Country:US
Mailing Address - Phone:702-533-3711
Mailing Address - Fax:
Practice Address - Street 1:3721 FREEDOM CIRCLE
Practice Address - Street 2:BLDG 1770A
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-8919
Practice Address - Country:US
Practice Address - Phone:702-679-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
NV05065062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer