Healthcare Provider Details

I. General information

NPI: 1053064436
Provider Name (Legal Business Name): MICHELLE THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W MAIN ST
AUSTIN IN
47102-1303
US

IV. Provider business mailing address

BUSINESS OFFICE: 802 OVERHILL DR
SHEPHERDSVILLE KY
40165-7252
US

V. Phone/Fax

Practice location:
  • Phone: 812-794-8100
  • Fax: 812-794-8200
Mailing address:
  • Phone: 502-543-9124
  • Fax: 502-543-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017329
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015840A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: