Healthcare Provider Details

I. General information

NPI: 1598045833
Provider Name (Legal Business Name): REBECCA ANN THOMPSON WHNP-BC, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 REBEL DRIVE
UNIVERSITY MS
38677
US

IV. Provider business mailing address

400 REBEL DRIVE
UNIVERSITY MS
38677
US

V. Phone/Fax

Practice location:
  • Phone: 662-915-7274
  • Fax: 662-915-5292
Mailing address:
  • Phone: 662-915-7274
  • Fax: 662-915-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR670446
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN15987
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR670446
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: