Provider Demographics
NPI:1841153491
Name:THOMPSON, JACQUELINE DARSHICA
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DARSHICA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W 61ST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-1902
Mailing Address - Country:US
Mailing Address - Phone:563-726-3237
Mailing Address - Fax:
Practice Address - Street 1:515 W 61ST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-1902
Practice Address - Country:US
Practice Address - Phone:563-726-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-09
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health