Active NPI
Jennifer Thompson
- Acute Care Nurse Practitioner
- Gainesville, GA
National Provider Identifier
1336706464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- RN215493
- 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, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| RN215493 | GA | MD | Gerontology 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.