Provider Demographics
NPI:1710226204
Name:THOMPSON, TARA RAE (APRN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:RAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1698 E MCANDREWS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5590
Mailing Address - Country:US
Mailing Address - Phone:541-732-7400
Mailing Address - Fax:541-732-3410
Practice Address - Street 1:1698 E MCANDREWS RD STE 400
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5590
Practice Address - Country:US
Practice Address - Phone:541-732-7400
Practice Address - Fax:541-732-3410
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP 07195363LW0102X
WAAP61501809363LW0102X
OR10018842APRN-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10018842OtherOREGON BOARD OF NURSING
LAPA 080109OtherLOUISIANA STATE BOARD OF NURSING PRESCRIPTIVE AUTHORITY
LA2337483Medicaid
WAAP61501809OtherWASHINGTON BOARD OF NURSING