Healthcare Provider Details

I. General information

NPI: 1508839739
Provider Name (Legal Business Name): VANESSA THOMPSON PMHNP-GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 SOUTH CHURCH STREET UNIT 213
SPARTANBURG SC
29306-3412
US

IV. Provider business mailing address

PO BOX 128
INMAN SC
29349-0128
US

V. Phone/Fax

Practice location:
  • Phone: 864-216-3868
  • Fax:
Mailing address:
  • Phone: 864-216-3868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number54104
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: