Provider Demographics
NPI:1912531856
Name:THOMPSON, EDWARD BENJAMIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:BENJAMIN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 FARMVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-6105
Mailing Address - Country:US
Mailing Address - Phone:865-405-9102
Mailing Address - Fax:
Practice Address - Street 1:9051 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4606
Practice Address - Country:US
Practice Address - Phone:865-337-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily