Provider Demographics
NPI:1508839739
Name:THOMPSON, VANESSA (PMHNP-GNP-BC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PMHNP-GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-0128
Mailing Address - Country:US
Mailing Address - Phone:864-216-3868
Mailing Address - Fax:
Practice Address - Street 1:300 JOHN ST STE 5B
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1463
Practice Address - Country:US
Practice Address - Phone:864-216-3868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC54104363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004135Medicaid
SCNP0982Medicaid
SCP97445Medicare PIN
SCP00076767Medicare PIN
SCAA93027652Medicare PIN
SCP974454710Medicare PIN
SCP974458452Medicare PIN
NC7004135Medicaid