Provider Demographics
NPI:1548205966
Name:THOMPSON, LAURA M (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:WREYFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:54 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3050
Mailing Address - Country:US
Mailing Address - Phone:573-348-8399
Mailing Address - Fax:573-348-8309
Practice Address - Street 1:304A E 4TH ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1808
Practice Address - Country:US
Practice Address - Phone:573-557-2400
Practice Address - Fax:573-557-2401
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP768A363L00000X
IDNP-768A363L00000X
ARA01136 ANP363LA2200X, 363LG0600X
MO2017022385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159959729Medicaid
ID807560800Medicaid
AZ043409Medicare Oscar/Certification
ID807560800Medicaid