Provider Demographics
NPI:1619121290
Name:THOMPSON, DAVID E (NP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:MCBEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101
Mailing Address - Country:US
Mailing Address - Phone:843-335-8291
Mailing Address - Fax:843-335-8731
Practice Address - Street 1:40 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9406
Practice Address - Country:US
Practice Address - Phone:803-408-3262
Practice Address - Fax:803-408-8895
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1748Medicaid