Provider Demographics
NPI:1003925637
Name:THOMPSON, TOMIE (ARNP)
Entity Type:Individual
Prefix:
First Name:TOMIE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASHLAND DR
Mailing Address - Street 2:STE G1
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7084
Mailing Address - Country:US
Mailing Address - Phone:606-833-4043
Mailing Address - Fax:
Practice Address - Street 1:1000 ASHLAND DR
Practice Address - Street 2:STE G1
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7084
Practice Address - Country:US
Practice Address - Phone:606-833-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3807P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78008844Medicaid
KY000000530747OtherBCBS
OH2452902Medicaid
KY180036Medicare Oscar/Certification
KY3400070Medicare PIN
OH2452902Medicaid