Provider Demographics
NPI:1750621900
Name:THOMPSON, AMITY MCDONALD (ACNP BC)
Entity type:Individual
Prefix:MS
First Name:AMITY
Middle Name:MCDONALD
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ACNP BC
Other - Prefix:MS
Other - First Name:AMITY
Other - Middle Name:LEE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:3535 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5705
Mailing Address - Country:US
Mailing Address - Phone:228-762-3000
Mailing Address - Fax:
Practice Address - Street 1:3603 BIENVILLE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5727
Practice Address - Country:US
Practice Address - Phone:228-762-3000
Practice Address - Fax:228-818-4151
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRN883535363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care