Healthcare Provider Details

I. General information

NPI: 1982680799
Provider Name (Legal Business Name): SUZANNE THOMPSON APRN, BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SUZANNE NELSON APRN, BC, FNP

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W. JEFFERSON ST. SUITE C
CONWAY MO
65632
US

IV. Provider business mailing address

601 W. JEFFERSON ST. P.O. BOX 9
CONWAY MO
65632
US

V. Phone/Fax

Practice location:
  • Phone: 417-589-2050
  • Fax: 417-589-4046
Mailing address:
  • Phone: 417-589-2050
  • Fax: 417-589-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN092954
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: