Provider Demographics
NPI:1760276273
Name:THOMPSON, AUDREY NICOLE (PMHNP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25628 CHINQUAPIN
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-7392
Mailing Address - Country:US
Mailing Address - Phone:417-850-9792
Mailing Address - Fax:
Practice Address - Street 1:2908 MILITARY AVE
Practice Address - Street 2:
Practice Address - City:BAXTER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66713-2331
Practice Address - Country:US
Practice Address - Phone:620-240-9221
Practice Address - Fax:417-459-4791
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-84247-082363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health