Provider Demographics
NPI:1689866568
Name:THOMPSON, PATRICIA R (APRN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3011 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2546
Mailing Address - Country:US
Mailing Address - Phone:620-231-9873
Mailing Address - Fax:620-231-2808
Practice Address - Street 1:604 UNION ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-6020
Practice Address - Country:US
Practice Address - Phone:620-251-4300
Practice Address - Fax:620-251-4979
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2020-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK123181363LF0000X
KS46097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200414220AMedicaid
KS200594330DMedicaid
110931016Medicare Oscar/Certification