Healthcare Provider Details

I. General information

NPI: 1538540745
Provider Name (Legal Business Name): MINDY DAWN THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 N HOWARD AVE
LANDRUM SC
29356-1507
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-457-3838
  • Fax: 864-457-4159
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19479
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: