Healthcare Provider Details

I. General information

NPI: 1184425480
Provider Name (Legal Business Name): STACY-ANN NICOLE THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

IV. Provider business mailing address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6000
  • Fax:
Mailing address:
  • Phone: 518-549-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number694678
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number694678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: