Provider Demographics
NPI:1134527096
Name:THOMPSON, JAHVEL (PA)
Entity type:Individual
Prefix:
First Name:JAHVEL
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 W. SPRING VALLEY RD.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240
Mailing Address - Country:US
Mailing Address - Phone:214-884-1705
Mailing Address - Fax:214-884-1711
Practice Address - Street 1:8112 W. SPRING VALLEY RD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:214-884-1705
Practice Address - Fax:214-884-1711
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA09284OtherTEXAS MEDICAL BOARD