Provider Demographics
NPI:1710608427
Name:THOMPSON, EDWIN (CRNA)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 KENSINGTON CV
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7519
Mailing Address - Country:US
Mailing Address - Phone:870-329-4469
Mailing Address - Fax:
Practice Address - Street 1:10 KENSINGTON CV
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7519
Practice Address - Country:US
Practice Address - Phone:870-329-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ144160367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered