Provider Demographics
NPI:1639779069
Name:THOMPSON, MARANDA KAY (CRNP)
Entity Type:Individual
Prefix:
First Name:MARANDA
Middle Name:KAY
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 1:20 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-3382
Mailing Address - Country:US
Mailing Address - Phone:205-338-8008
Mailing Address - Fax:205-338-8009
Practice Address - Street 1:20 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-3382
Practice Address - Country:US
Practice Address - Phone:205-338-8008
Practice Address - Fax:205-338-8009
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-140958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner