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General NPI Number Information
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NPI Number | 1962258244
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Entity Type | Individual
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Provider Name | ANGELIA PICKETT THOMPSON FNP
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Gender | Female
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 1721 EBENEZER RD STE 145
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City | ROCK HILL
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State | SC
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Zip | 29732-1119
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Country | US
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Telephone | 803-328-2401
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Fax | 803-328-1030
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Provider Business Mailing Address
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Address Line | 4715 WESTWIND DR
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City | ROCK HILL
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State | SC
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Zip | 29732-9194
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Country | US
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Telephone | 803-372-8569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 29040
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 64839
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License Number State | SC
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