Provider Demographics
NPI:1487096780
Name:THOMPSON, GERALD KEVIN (ARNP, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:KEVIN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4542
Mailing Address - Country:US
Mailing Address - Phone:850-763-0017
Mailing Address - Fax:850-532-6454
Practice Address - Street 1:1940 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4542
Practice Address - Country:US
Practice Address - Phone:850-763-0017
Practice Address - Fax:850-532-6454
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-27
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124311163WP0808X, 163WR0400X, 163W00000X, 163WA0400X, 163WG0000X, 163WH0200X, 163WW0000X
FLARNP9444970363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care