=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700889367
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL A THOMPSON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1825 ATCHISON AVE
-----------------------------------------------------
City | MARSHALL
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65340-9752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-886-8584
-----------------------------------------------------
Fax | 660-827-8992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 W MAIN ST
-----------------------------------------------------
City | SEDALIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65301-3821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-826-4774
-----------------------------------------------------
Fax | 660-827-8992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 108706
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------