Provider Demographics
NPI:1710307848
Name:THOMPSON, TERA R (APRN)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AR
Mailing Address - Zip Code:72744-0810
Mailing Address - Country:US
Mailing Address - Phone:479-824-3196
Mailing Address - Fax:479-824-4397
Practice Address - Street 1:106 E PARK ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:AR
Practice Address - Zip Code:72744-8706
Practice Address - Country:US
Practice Address - Phone:479-824-3196
Practice Address - Fax:479-824-4397
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily