Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3807P | KY |
NPI | 1003925637 |
---|---|
Provider Name | Tomie Thompson |
First Address | Ashland, KY 41101-7084 |
Second Address | Ashland, KY 41101-7084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 10/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000530747 | BCBS (01) | KY |
2452902 | (05) | OH |
78008844 | (05) | KY |