Healthcare Provider Details

I. General information

NPI: 1972043685
Provider Name (Legal Business Name): ANN CHRISTINE THOMPSON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MILE DRIVE
OTISVILLE NY
10963
US

IV. Provider business mailing address

89 GOSHEN TPKE
BLOOMINGBURG NY
12721-3145
US

V. Phone/Fax

Practice location:
  • Phone: 845-386-6700
  • Fax:
Mailing address:
  • Phone: 570-579-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: