Provider Demographics
NPI:1093902249
Name:THOMPSON, STEPHANIE MARIE (ANP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-878-1950
Mailing Address - Fax:314-878-3022
Practice Address - Street 1:1040 N MASON RD
Practice Address - Street 2:STE 206
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6399
Practice Address - Country:US
Practice Address - Phone:314-878-1950
Practice Address - Fax:314-878-3022
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005037485363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO836800183Medicaid
MO836800183Medicare PIN