Provider Demographics
NPI:1851834329
Name:THOMPSON, EMILY ELIZABETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 PROSPERITY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880-9188
Mailing Address - Country:US
Mailing Address - Phone:304-731-3209
Mailing Address - Fax:
Practice Address - Street 1:1802 HARPER RD
Practice Address - Street 2:#102
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3375
Practice Address - Country:US
Practice Address - Phone:204-252-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN83716-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily