Healthcare Provider Details

I. General information

NPI: 1346178787
Provider Name (Legal Business Name): MISS LEEAH FAITH THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 WESTHAVEN SCHOOL RD
BELLEVILLE IL
62220-3264
US

IV. Provider business mailing address

118 WESTHAVEN SCHOOL RD
BELLEVILLE IL
62220-3264
US

V. Phone/Fax

Practice location:
  • Phone: 618-257-9201
  • Fax: 618-257-9310
Mailing address:
  • Phone: 618-257-9201
  • Fax: 618-257-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number041549980
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: