Provider Demographics
NPI:1417372400
Name:THOMPSON, PAMELA JANE (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 AIRPORT BLVD STE 3-307
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2235
Mailing Address - Country:US
Mailing Address - Phone:251-478-8671
Mailing Address - Fax:251-478-6174
Practice Address - Street 1:3929 AIRPORT BLVD STE 3-307
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2235
Practice Address - Country:US
Practice Address - Phone:251-478-8671
Practice Address - Fax:251-478-6174
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR857524OtherMISSISSIPPI NP LIC