Provider Demographics
NPI:1609846864
Name:THOMPSON, DEBORAH W (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:W
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CRNP
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 97
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0097
Mailing Address - Country:US
Mailing Address - Phone:256-492-0131
Mailing Address - Fax:
Practice Address - Street 1:927 RALEY ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-2027
Practice Address - Country:US
Practice Address - Phone:256-439-6384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176817 NP363L00000X
AL1-051443363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL134172 (CNTRBRY)Medicaid
GA543959872AMedicaid
AL134171 (COMPLEX)Medicaid
AL102I504959 (COMPLEX)Medicare PIN
AL134172 (CNTRBRY)Medicaid
AL134171 (COMPLEX)Medicaid
AL10250I4960 (CNTRBRY)Medicare PIN