Healthcare Provider Details

I. General information

NPI: 1215561741
Provider Name (Legal Business Name): SAMANTHA PAIGE THOMPSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 5TH ST
FULTON MO
65251-1793
US

IV. Provider business mailing address

600 E 5TH ST
FULTON MO
65251-1793
US

V. Phone/Fax

Practice location:
  • Phone: 573-592-4100
  • Fax:
Mailing address:
  • Phone: 573-592-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020006449
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: