Provider Demographics
NPI:1811388739
Name:THOMPSON, JAYE RACHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:JAYE
Middle Name:RACHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
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 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-301-2092
Practice Address - Street 1:615 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-2507
Practice Address - Country:US
Practice Address - Phone:870-734-1150
Practice Address - Fax:870-734-1179
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR201481729Medicaid
AR201478729Medicaid
AR201479729Medicaid
AR201477729Medicaid
AR201482729Medicaid
AR203673729Medicaid
AR201479729Medicaid
AR201477729Medicaid
AR56965Medicare PIN
AR048505Medicare Oscar/Certification
AR201478729Medicaid
AR043457Medicare Oscar/Certification
AR040072Medicare Oscar/Certification
AR201481729Medicaid