Provider Demographics
NPI:1902926488
Name:THOMPSON, PATRICIA A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-582-5461
Practice Address - Street 1:598 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:MS
Practice Address - Zip Code:39455-2350
Practice Address - Country:US
Practice Address - Phone:601-796-4214
Practice Address - Fax:601-796-9437
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1825069Medicaid
MS2788583OtherUNITED HEALTH CARE
MSP00445052OtherRAILROAD MEDICARE
MS05438580Medicaid
MS9229279OtherAETNA
MS9229279OtherAETNA