Provider Demographics
NPI:1801609045
Name:THOMPSON, JACQULINE LANE (ARNP)
Entity type:Individual
Prefix:
First Name:JACQULINE
Middle Name:LANE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LACONA
Mailing Address - State:IA
Mailing Address - Zip Code:50139-1006
Mailing Address - Country:US
Mailing Address - Phone:515-402-0477
Mailing Address - Fax:
Practice Address - Street 1:2006 N 4TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125
Practice Address - Country:US
Practice Address - Phone:515-461-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA182650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine