Provider Demographics
NPI:1477124881
Name:THOMPSON, HEATHER BLUE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BLUE
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 1:502 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1407
Mailing Address - Country:US
Mailing Address - Phone:931-299-5001
Mailing Address - Fax:931-299-5003
Practice Address - Street 1:502 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1407
Practice Address - Country:US
Practice Address - Phone:931-299-5001
Practice Address - Fax:931-299-5003
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29758363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily