Healthcare Provider Details

I. General information

NPI: 1053981241
Provider Name (Legal Business Name): MOLLY CHRISTINE THOMPSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S 6TH ST
NEVADA IA
50201-2521
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5469
US

V. Phone/Fax

Practice location:
  • Phone: 515-382-5471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO-06645
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021023496
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: