Provider Demographics
NPI:1417400755
Name:THOMPSON, STACI DIANE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:DIANE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 S. DIXON ROAD
Mailing Address - Street 2:AMERICAN HEALTH NETWORK
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902
Mailing Address - Country:US
Mailing Address - Phone:765-455-5400
Mailing Address - Fax:
Practice Address - Street 1:2330 S. DIXON ROAD
Practice Address - Street 2:AMERICAN HEALTH NETWORK
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902
Practice Address - Country:US
Practice Address - Phone:765-455-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006408A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily