Healthcare Provider Details

I. General information

NPI: 1962258244
Provider Name (Legal Business Name): ANGELIA PICKETT THOMPSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 EBENEZER RD STE 145
ROCK HILL SC
29732-1119
US

IV. Provider business mailing address

4715 WESTWIND DR
ROCK HILL SC
29732-9194
US

V. Phone/Fax

Practice location:
  • Phone: 803-328-2401
  • Fax: 803-328-1030
Mailing address:
  • Phone: 803-372-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29040
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number64839
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: