Provider Demographics
NPI:1467457341
Name:COMPTON, JENNIFER C (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:COMPTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-390-3339
Practice Address - Street 1:4848 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3347
Practice Address - Country:US
Practice Address - Phone:423-857-2066
Practice Address - Fax:423-857-2066
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000275363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5645956OtherVA MEDICAID
TN830342546OtherJOHN DEERE
TN103I977037Medicaid
TN080194591OtherRAILROAD MEDICARE
VA246269OtherANTHEM BCBS VA
TN4059748OtherBCBS TN
VA5645956OtherVA MEDICAID
TN103I977037Medicare PIN