Healthcare Provider Details

I. General information

NPI: 1508534009
Provider Name (Legal Business Name): ELIZABETH THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 FREDERICA STREET SUITE 1
OWENSBORO KY
42301-4230
US

IV. Provider business mailing address

3245 MOUNT MORIAH AVE STE 10
OWENSBORO KY
42303-7834
US

V. Phone/Fax

Practice location:
  • Phone: 270-240-3633
  • Fax:
Mailing address:
  • Phone: 270-663-0955
  • Fax: 270-574-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016154
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: