Healthcare Provider Details

I. General information

NPI: 1841493350
Provider Name (Legal Business Name): CARRIE A THOMPSON M.S.N., OCN, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/27/2023
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

320 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-7441
  • Fax: 406-257-0304
Mailing address:
  • Phone: 406-752-7441
  • Fax: 406-257-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP774A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30971
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: