Healthcare Provider Details

I. General information

NPI: 1306592696
Provider Name (Legal Business Name): CARISSA DANIELLE THOMPSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARISSA DANIELLE MUELLER RN

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 NORTHSTAR DR
HOLTS SUMMIT MO
65043-1123
US

IV. Provider business mailing address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

V. Phone/Fax

Practice location:
  • Phone: 573-469-7046
  • Fax: 573-882-4523
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-246-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022004948
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: