Provider Demographics
NPI:1831956291
Name:THOMPSON, STEPHANIE WILLARD (FNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:WILLARD
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LEA
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:430 BOXWOOD LN
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1168
Practice Address - Country:US
Practice Address - Phone:540-921-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001238197163WC0200X
VA0024191363363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine