Provider Demographics
NPI:1417372400
Name:THOMPSON, PAMELA JANE (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482-3702
Mailing Address - Country:US
Mailing Address - Phone:251-847-3374
Mailing Address - Fax:251-847-3374
Practice Address - Street 1:348 KNIGHT RD
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482-3702
Practice Address - Country:US
Practice Address - Phone:251-847-3374
Practice Address - Fax:251-847-3374
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR857524OtherMISSISSIPPI NP LIC