Provider Demographics
NPI:1376093294
Name:THOMPSON, JENNELLE ASHLEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNELLE
Middle Name:ASHLEY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1608 N ROAD 44
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2667
Mailing Address - Country:US
Mailing Address - Phone:509-543-9280
Mailing Address - Fax:509-545-6275
Practice Address - Street 1:1608 N ROAD 44
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2667
Practice Address - Country:US
Practice Address - Phone:509-543-9280
Practice Address - Fax:509-545-6275
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60705026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant