Provider Demographics
NPI:1861963993
Name:THOMPSON, CAROL LEIGH ANNE
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LEIGH ANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LEIGH ANNE
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2449 SUMMERWOOD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-2216
Mailing Address - Country:US
Mailing Address - Phone:601-508-7789
Mailing Address - Fax:
Practice Address - Street 1:2449 SUMMERWOOD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-2216
Practice Address - Country:US
Practice Address - Phone:601-508-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTHOM-9BJFWB363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily