Healthcare Provider Details

I. General information

NPI: 1154729135
Provider Name (Legal Business Name): ANTOINETTE M THOMPSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 UNIVERSITY AVE
WEST DES MOINES IA
50266-1962
US

IV. Provider business mailing address

5223 WINDSOR CT
PLEASANT HILL IA
50327-0992
US

V. Phone/Fax

Practice location:
  • Phone: 515-985-2676
  • Fax:
Mailing address:
  • Phone: 405-640-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number82169
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number82169
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA142312
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: