Provider Demographics
NPI:1245308436
Name:THOMPSON, LESLIE J (FNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9855
Mailing Address - Fax:812-858-4536
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9855
Practice Address - Fax:812-858-4536
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001284A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200365440Medicaid
KY78007234OtherKY MEDICAID
IN000000281995OtherANTHEM
IN500023944Medicare PIN
IN849800HHHMedicare PIN
KY78007234OtherKY MEDICAID
257900LLLMedicare PIN