Healthcare Provider Details

I. General information

NPI: 1164417903
Provider Name (Legal Business Name): SONDRA MICHELLE THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONDRA MICHELLE STATUM NP

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 HILLSBORO RD
NASHVILLE TN
37215-2603
US

IV. Provider business mailing address

445 CREST DR
LYNCHBURG TN
37352-7068
US

V. Phone/Fax

Practice location:
  • Phone: 615-385-0622
  • Fax:
Mailing address:
  • Phone: 931-703-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN0000067551
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000005971
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: