Provider Demographics
NPI:1851759807
Name:THOMPSON, DESIREE A (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 BUSH DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8329
Mailing Address - Country:US
Mailing Address - Phone:616-951-2305
Mailing Address - Fax:
Practice Address - Street 1:1728 W BLUEWATER HWY
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-8553
Practice Address - Country:US
Practice Address - Phone:616-527-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254997363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health