Provider Demographics
NPI:1649991167
Name:JENNIFERTHOMPSON FNP-BC LLC
Entity type:Organization
Organization Name:JENNIFERTHOMPSON FNP-BC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:540-424-4013
Mailing Address - Street 1:10500 WAKEMAN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8012
Mailing Address - Country:US
Mailing Address - Phone:540-358-8725
Mailing Address - Fax:540-242-3426
Practice Address - Street 1:10500 WAKEMAN DR STE 105
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8012
Practice Address - Country:US
Practice Address - Phone:540-358-8725
Practice Address - Fax:540-242-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508940214OtherINDIVIDUAL NPI
VA1508940214Medicaid