Provider Demographics
NPI:1053064436
Name:THOMPSON, MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUSINESS OFFICE: 802 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7252
Mailing Address - Country:US
Mailing Address - Phone:502-543-9124
Mailing Address - Fax:502-543-0844
Practice Address - Street 1:BUSINESS OFFICE: 802 OVERHILL DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7252
Practice Address - Country:US
Practice Address - Phone:502-543-9124
Practice Address - Fax:502-543-0844
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid