Provider Demographics
NPI:1326800939
Name:PTHOMPSON ADVANCE PRACTICE
Entity Type:Organization
Organization Name:PTHOMPSON ADVANCE PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHILLISHA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-665-8111
Mailing Address - Street 1:6024 FLY FISHER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1728
Mailing Address - Country:US
Mailing Address - Phone:623-533-9850
Mailing Address - Fax:702-551-9276
Practice Address - Street 1:6260 MCLEOD DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4445
Practice Address - Country:US
Practice Address - Phone:702-665-8111
Practice Address - Fax:702-551-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center