Provider Demographics
NPI:1750733937
Name:THOMPSON, COLLEEN ADELE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ADELE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ADELE
Other - Last Name:STOGSDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8105 N OAK TRFY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1202
Mailing Address - Country:US
Mailing Address - Phone:816-562-6466
Mailing Address - Fax:
Practice Address - Street 1:5950 UNIVERSITY AVE STE 341
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-875-9800
Practice Address - Fax:515-875-9802
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016013950363L00000X, 363LA2100X, 363LA2200X, 363LG0600X
MO2020010067363LA2200X
IAH149695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology