Provider Demographics
NPI:1609452960
Name:THOMPSON, DUSTIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 W 1500 S
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9475
Mailing Address - Country:US
Mailing Address - Phone:801-682-6955
Mailing Address - Fax:
Practice Address - Street 1:520 MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8925
Practice Address - Country:US
Practice Address - Phone:801-292-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9784958-8900363LP2300X
UT9784958-4405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care