Healthcare Provider Details

I. General information

NPI: 1396360129
Provider Name (Legal Business Name): SAMANTHA J THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 4TH ST
HAVRE MT
59501-3649
US

IV. Provider business mailing address

521 4TH ST
HAVRE MT
59501-3649
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4305
  • Fax: 406-395-4858
Mailing address:
  • Phone: 406-395-4305
  • Fax: 406-395-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number160121
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number160121
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: