1760276273 NPI number — AUDREY NICOLE THOMPSON PMHNP

Table of content: WILLIAM MASON CARROLL (NPI 1902502297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760276273 NPI number — AUDREY NICOLE THOMPSON PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
AUDREY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
NIKKI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1760276273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25628 CHINQUAPIN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64801-7392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-850-9792
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2908 MILITARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAXTER SPRINGS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66713-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-240-9221
Provider Business Practice Location Address Fax Number:
417-459-4791
Provider Enumeration Date:
04/08/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  53-84247-082 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)