MEDICARE: MARY ABIGAIL THOMPSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4057095	KY

General Provider Information

NPI Number	:	1770416141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ABIGAIL THOMPSON NP

Provider Business Mailing Address
First Line	:	PO BOX 950132
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3810 SPRINGHURST BLVD STE 200
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-6162
Country	:	US
Telephone Number	:	502-583-1749
Fax Number	:	502-329-7599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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