Healthcare Provider Details

I. General information

NPI: 1225658206
Provider Name (Legal Business Name): BRANDI S THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 WILBORN AVE
SOUTH BOSTON VA
24592-1662
US

IV. Provider business mailing address

2232 WILBORN AVE
SOUTH BOSTON VA
24592-1662
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-8977
  • Fax:
Mailing address:
  • Phone: 434-572-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024179150
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: