Provider Demographics
NPI:1831282995
Name:THOMPSON, CHRISTIANA MARIE (CNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIANA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2941
Mailing Address - Country:US
Mailing Address - Phone:870-492-5995
Mailing Address - Fax:870-508-8900
Practice Address - Street 1:250 DRILLERS RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5186
Practice Address - Country:US
Practice Address - Phone:870-492-5995
Practice Address - Fax:870-508-8900
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARANP1284363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141528758Medicaid
AR141528758Medicaid