=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962129866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD P. THOMPSON NURSE PRACTITIONER OF PSYCHIATRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2022
-----------------------------------------------------
Last Update Date | 10/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 262 S MAIN AVE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12208-2432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-406-2269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 262 S MAIN AVE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12208-2432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-406-2269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER IN PSYCHIATRY
-----------------------------------------------------
Name | MR. EDWARD PALMER THOMPSON
-----------------------------------------------------
Credential | DNP, NP, PMHNP-BC
-----------------------------------------------------
Telephone | 251-406-2269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------