Provider Demographics
NPI:1942299599
Name:THOMPSON, PEPE L (ACNP)
Entity Type:Individual
Prefix:
First Name:PEPE
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N OAK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2435
Mailing Address - Country:US
Mailing Address - Phone:931-783-5857
Mailing Address - Fax:931-526-6760
Practice Address - Street 1:145 W 4TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2447
Practice Address - Country:US
Practice Address - Phone:931-783-2143
Practice Address - Fax:931-783-2152
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8346363L00000X, 363LA2100X
KY3013387363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3990989Medicaid
TN4271773OtherBCBS
KY7100448910Medicaid
TN3900988Medicaid
TN3990989Medicaid
KY7100448910Medicaid