MEDICARE: MS. VICKI A. THOMPSON NP ( CRNP)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-072299	AL

General Provider Information

NPI Number	:	1205816956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI A. THOMPSON NP ( CRNP)

Provider Business Mailing Address
First Line	:	44533 PINE GROVE ROAD
Second Line	:	PO BOX 226
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-0226
Country	:	US
Telephone Number	:	251-937-7012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1903 HAND AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4112
Country	:	US
Telephone Number	:	251-937-7970
Fax Number	:	251-937-9260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	04/08/2011

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