Provider Demographics
NPI:1205816956
Name:THOMPSON, VICKI A (NP ( CRNP))
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP ( CRNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44533 PINE GROVE ROAD
Mailing Address - Street 2:PO BOX 226
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-0226
Mailing Address - Country:US
Mailing Address - Phone:251-937-7012
Mailing Address - Fax:
Practice Address - Street 1:1903 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4112
Practice Address - Country:US
Practice Address - Phone:251-937-7970
Practice Address - Fax:251-937-9260
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-072299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS63460Medicare UPIN