Provider Demographics
NPI:1952034654
Name:THOMPSON, CARLI BURCH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARLI
Middle Name:BURCH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 N 700 W STE 110
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5754
Mailing Address - Country:US
Mailing Address - Phone:801-686-5015
Mailing Address - Fax:
Practice Address - Street 1:1916 N 700 W STE 110
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5754
Practice Address - Country:US
Practice Address - Phone:801-686-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF07220505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF07220505OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS