Provider Demographics
NPI:1508039769
Name:THOMPSON, DEANN LOIS
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:LOIS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANN
Other - Middle Name:LOIS
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NPC
Mailing Address - Street 1:HC 71 BOX 209
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-8910
Mailing Address - Country:US
Mailing Address - Phone:417-683-9268
Mailing Address - Fax:
Practice Address - Street 1:120 SOUTH WEST 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608
Practice Address - Country:US
Practice Address - Phone:417-683-6790
Practice Address - Fax:417-683-6770
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner