Healthcare Provider Details

I. General information

NPI: 1700454220
Provider Name (Legal Business Name): ELAINE MARY THOMPSON DNP, CNM, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELAINE MARY MCCORMICK

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S MEDICAL DR
MOUNT PLEASANT UT
84647-2222
US

IV. Provider business mailing address

11021 E 16000 N
MOUNT PLEASANT UT
84647-5651
US

V. Phone/Fax

Practice location:
  • Phone: 435-462-3471
  • Fax:
Mailing address:
  • Phone: 801-367-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number500988-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number500988-4402
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number500988-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: