Provider Demographics
NPI:1295893998
Name:THOMPSON, SHIRLEY (APRN, BC, FNP, GNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN, BC, FNP, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2222
Mailing Address - Country:US
Mailing Address - Phone:660-263-6643
Mailing Address - Fax:660-263-0333
Practice Address - Street 1:423 E LOGAN ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2222
Practice Address - Country:US
Practice Address - Phone:660-263-6643
Practice Address - Fax:660-263-0333
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO062220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO062220OtherLICENSE