Provider Demographics
NPI:1417434200
Name:THOMPSON, HEATHER ANN (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 N MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-2908
Mailing Address - Country:US
Mailing Address - Phone:606-753-6013
Mailing Address - Fax:606-753-6020
Practice Address - Street 1:1520 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2908
Practice Address - Country:US
Practice Address - Phone:606-753-6013
Practice Address - Fax:606-753-6020
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100627300Medicaid