Provider Demographics
NPI:1073965166
Name:THOMPSON, REBECCA ROSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:181 COUNTY ROAD 53
Mailing Address - Street 2:
Mailing Address - City:DOUBLE SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35553-2413
Mailing Address - Country:US
Mailing Address - Phone:838-218-2488
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1108
Practice Address - Country:US
Practice Address - Phone:518-836-3030
Practice Address - Fax:518-836-3020
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031845363L00000X
NY340860363LF0000X
AL1-198663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner