NPI 1134850365

Jasper Devonta Thompson

Practitioner Driver Laurel, MS

Practice location

Address: 111 Palisades Park Cv, Laurel, MS 39440-6600
Phone: (601) 470-3916

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 802211659 (MS)

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Registry record

NPI: 1134850365
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 Jun 2022
Record last updated: 20 Jun 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.