Provider Demographics
NPI:1215190657
Name:THOMPSON, NATALIE K (PMHNP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:K
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NORTH STATE ST.
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-373-2001
Mailing Address - Fax:
Practice Address - Street 1:1900 N STATE ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1305
Practice Address - Country:US
Practice Address - Phone:801-373-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0016X
OR200850067NP363LP0808X
UT9824823-8900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)