Provider Demographics
NPI:1851992549
Name:THOMPSON, MEGAN LEANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LEANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MCKENZIE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:118 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3107
Mailing Address - Country:US
Mailing Address - Phone:662-534-0898
Mailing Address - Fax:662-534-8905
Practice Address - Street 1:118 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3107
Practice Address - Country:US
Practice Address - Phone:662-534-0898
Practice Address - Fax:662-534-8905
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904619363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS003507781Medicaid