Provider Demographics
NPI:1689318875
Name:THOMPSON, AMANDA KAY (PNP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:KAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6124
Mailing Address - Fax:844-616-1418
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED RHEUMATOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6124
Practice Address - Fax:844-616-1418
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018032288363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420111788Medicaid