Provider Demographics
NPI:1720067457
Name:THOMPSON, COLETTE (FNP)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:247 UNION POINT ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648-2303
Practice Address - Country:US
Practice Address - Phone:706-743-8171
Practice Address - Fax:706-743-3000
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR607355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA393908547AMedicaid
GA235388463AMedicaid
GA50BBGQJMedicare PIN
GA235388463AMedicaid
GA50BBHJJMedicare PIN