Provider Demographics
NPI:1164079828
Name:THOMPSON, IVY ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:IVY
Middle Name:ELIZABETH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:IVY
Other - Middle Name:ELIZABETH
Other - Last Name:REGISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 N DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1019
Mailing Address - Country:US
Mailing Address - Phone:302-450-3481
Mailing Address - Fax:302-430-5679
Practice Address - Street 1:800 N DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1019
Practice Address - Country:US
Practice Address - Phone:302-430-5705
Practice Address - Fax:302-430-5679
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104266363LF0000X
DELG-0012661363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1164079828Medicaid
DE250775533Medicaid