Provider Demographics
NPI:1659086296
Name:THOMISON, CAROL (MSN, AGPCNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:THOMISON
Suffix:
Gender:F
Credentials:MSN, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MAGNOLIA VALE DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-2185
Mailing Address - Country:US
Mailing Address - Phone:423-825-1991
Mailing Address - Fax:
Practice Address - Street 1:1425 MCFARLAND AVE
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-2215
Practice Address - Country:US
Practice Address - Phone:423-825-1991
Practice Address - Fax:423-825-1992
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32976363LA2200X
GARN247679363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health