Provider Demographics
NPI:1679771711
Name:THOMPSON, SANDRA KIRKPATRICK (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KIRKPATRICK
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:355 S MADISON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5485
Mailing Address - Country:US
Mailing Address - Phone:336-599-8366
Mailing Address - Fax:336-322-6168
Practice Address - Street 1:355 S MADISON BLVD STE C
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5485
Practice Address - Country:US
Practice Address - Phone:336-599-8366
Practice Address - Fax:336-322-6168
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104122163WP0808X
NC5005448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health