Healthcare Provider Details

I. General information

NPI: 1295489672
Provider Name (Legal Business Name): DOROTHY IRICK THOMPSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CHERRY ST
TROY AL
36081-2044
US

IV. Provider business mailing address

5906 CARMICHAEL PL
MONTGOMERY AL
36117-2345
US

V. Phone/Fax

Practice location:
  • Phone: 334-566-3391
  • Fax:
Mailing address:
  • Phone: 334-409-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-144018
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: