Provider Demographics
NPI:1558375196
Name:THOMPSON, JANIE PARROTT (CRNA)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:PARROTT
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:PARROTT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4183 OLD FOREST RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3058
Mailing Address - Country:US
Mailing Address - Phone:901-756-2987
Mailing Address - Fax:
Practice Address - Street 1:4183 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-3058
Practice Address - Country:US
Practice Address - Phone:901-756-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS810076367500000X
TN11662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123263Medicaid
3628296Medicare ID - Type Unspecified