Provider Demographics
NPI:1245060698
Name:THOMPSON, JENNIFER KAHEALANI DRAKE (AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAHEALANI DRAKE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KAHEALANI
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:521 MONTREAL LN
Mailing Address - Street 2:
Mailing Address - City:SHIPMAN
Mailing Address - State:VA
Mailing Address - Zip Code:22971-2347
Mailing Address - Country:US
Mailing Address - Phone:573-397-2093
Mailing Address - Fax:
Practice Address - Street 1:2215 LANDOVER PL
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2115
Practice Address - Country:US
Practice Address - Phone:434-947-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191579363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care