Healthcare Provider Details

I. General information

NPI: 1568603306
Provider Name (Legal Business Name): TIFFANY THOMPSON CNMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

1737 MCDONALD LN
NEW ALBANY IN
47150-2413
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-5861
  • Fax:
Mailing address:
  • Phone: 812-941-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number029838
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: