Healthcare Provider Details

I. General information

NPI: 1144554221
Provider Name (Legal Business Name): BRIAN E THOMPSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

IV. Provider business mailing address

PO BOX 838
SHAWNEE MISSION KS
66201-0838
US

V. Phone/Fax

Practice location:
  • Phone: 816-698-7170
  • Fax: 816-698-7194
Mailing address:
  • Phone: 913-469-4244
  • Fax: 913-469-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2004029188
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: