Provider Demographics
NPI:1619507407
Name:THOMPSON, BRENDA A (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307
Mailing Address - Country:US
Mailing Address - Phone:601-581-7600
Mailing Address - Fax:601-581-7967
Practice Address - Street 1:1818 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307
Practice Address - Country:US
Practice Address - Phone:601-581-7600
Practice Address - Fax:601-581-7967
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903764363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty