Provider Demographics
NPI:1164417903
Name:THOMPSON, SONDRA MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:MICHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SONDRA
Other - Middle Name:MICHELLE
Other - Last Name:STATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:445 CREST DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37352-7068
Mailing Address - Country:US
Mailing Address - Phone:931-703-3710
Mailing Address - Fax:
Practice Address - Street 1:3801 HILLSBORO RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2603
Practice Address - Country:US
Practice Address - Phone:615-385-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000067551363LF0000X
TNAPN0000005971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3641413Medicare UPIN