Provider Demographics
NPI:1366730558
Name:THOMPSON, JERE WELCH (APRN-FNP)
Entity type:Individual
Prefix:
First Name:JERE
Middle Name:WELCH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 BURT BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-4900
Mailing Address - Country:US
Mailing Address - Phone:318-965-5017
Mailing Address - Fax:318-965-5019
Practice Address - Street 1:188 BURT BLVD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-4900
Practice Address - Country:US
Practice Address - Phone:318-965-5017
Practice Address - Fax:318-965-5019
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2164023Medicaid
LA721501844OtherTRICARE/HUMANA
MT2617148OtherDEA