Provider Demographics
NPI:1982680799
Name:THOMPSON, SUZANNE (APRN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC, FNP
Mailing Address - Street 1:601 W. JEFFERSON ST.
Mailing Address - Street 2:P.O. BOX 9
Mailing Address - City:CONWAY
Mailing Address - State:MO
Mailing Address - Zip Code:65632
Mailing Address - Country:US
Mailing Address - Phone:417-589-2050
Mailing Address - Fax:417-589-4046
Practice Address - Street 1:601 W. JEFFERSON ST.
Practice Address - Street 2:SUITE C
Practice Address - City:CONWAY
Practice Address - State:MO
Practice Address - Zip Code:65632
Practice Address - Country:US
Practice Address - Phone:417-589-2050
Practice Address - Fax:417-589-4046
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN092954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MORN092954OtherSTATE LICENS
MO26-3874Medicare ID - Type UnspecifiedMEDICARE NUMBER
MOP47140Medicare UPIN