Provider Demographics
NPI:1568158780
Name:THOMPSON, JOANNA (PMHNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 SANDY POINT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23030-4027
Mailing Address - Country:US
Mailing Address - Phone:804-332-5683
Mailing Address - Fax:
Practice Address - Street 1:3530 N COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE FORGE
Practice Address - State:VA
Practice Address - Zip Code:23140-3408
Practice Address - Country:US
Practice Address - Phone:804-409-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187624363LP0808X
VA0001200873163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program