Healthcare Provider Details

I. General information

NPI: 1215419551
Provider Name (Legal Business Name): TAMRA D THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PONDER CT STE C
DANVILLE KY
40422-9111
US

IV. Provider business mailing address

101 CITATION DR STE C
DANVILLE KY
40422-9227
US

V. Phone/Fax

Practice location:
  • Phone: 859-715-1408
  • Fax: 859-316-0081
Mailing address:
  • Phone: 859-715-1408
  • Fax: 859-316-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704437663
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012439
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70016453
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP251664
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71017306A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0039298
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number115537-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: