Individual provider Active NPI

Jennifer Thompson

  • Acute Care Nurse Practitioner
  • Gainesville, GA
National Provider Identifier
1336706464
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
RN215493 Issued in GA
Practice address
743 Spring St NE
Gainesville, GA 30501
Phone
(770) 219-9000
Fax
(770) 219-6021
NPI assigned
May 23, 2019
Last updated
Feb 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN215493 GA
Acute Care Nurse Practitioner 363LA2100X RN215493 GA Primary
Gerontology Nurse Practitioner 363LG0600X RN215493 GA

Addresses

Primary practice location

743 Spring St NE
Gainesville, GA 30501

Mailing address

PO Box 742616
Atlanta, GA 30374-2616
Phone (770) 219-8420

Other practice location 1

1360 Grey Rock Way
Suwanee, GA 30024-8573
Phone (404) 997-3162

Other practice location 2

743 Spring St NE
Gainesville, GA 30501
Phone (770) 219-9000

Other names 1

  • Jennifer Watson Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN215493GAMDGerontology Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1336706464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420",
            "fax_number": "770-219-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-219-9000",
            "fax_number": "770-219-6021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1360 Grey Rock Way",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300248573",
            "country_code": "US",
            "telephone_number": "404-997-3162",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "743 Spring St NE",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "30501",
            "country_code": "US",
            "telephone_number": "770-219-9000",
            "fax_number": "770-219-6021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-23",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN215493",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN215493",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "RN215493",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "20 Glenlake Pkwy",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303283473",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WATSON",
            "credential": "AG-ACNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.