Provider Demographics
NPI:1629510581
Name:THOMPSON, HEIDI V (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:V
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3056
Mailing Address - Country:US
Mailing Address - Phone:618-436-8000
Mailing Address - Fax:
Practice Address - Street 1:1250 W. WHITTAKER
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881
Practice Address - Country:US
Practice Address - Phone:618-548-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily