Provider Demographics
NPI:1144975954
Name:THOMPSON, MICHELLE BREANN (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BREANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-1945
Mailing Address - Country:US
Mailing Address - Phone:816-540-2111
Mailing Address - Fax:
Practice Address - Street 1:1601 RT-7
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080
Practice Address - Country:US
Practice Address - Phone:816-540-2111
Practice Address - Fax:816-540-6065
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022003486363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner