Provider Demographics
NPI:1770633034
Name:THOMPSON, ARDRIENNE H (FNP-C)
Entity Type:Individual
Prefix:
First Name:ARDRIENNE
Middle Name:H
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ARDRIENNE
Other - Middle Name:H
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:6320 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1545 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2306
Practice Address - Country:US
Practice Address - Phone:317-923-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001425A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01058803OtherRR MEDICARE PTAN
IN200405190Medicaid
INM400038226Medicare PIN
M400023161Medicare PIN
IN200405190Medicaid
INM400038224Medicare PIN
INM400038212Medicare PIN
INP01058803OtherRR MEDICARE PTAN
INM400053584Medicare PIN
IN266180338Medicare PIN
INM400038223Medicare PIN