Provider Demographics
NPI:1710084678
Name:THOMPSON, JEAN BENNETT (CFNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:BENNETT
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:LOUISE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:8950 LORRAINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503
Mailing Address - Country:US
Mailing Address - Phone:228-575-2770
Mailing Address - Fax:228-896-5374
Practice Address - Street 1:8950 LORRAINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-575-2770
Practice Address - Fax:228-896-5374
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily