Provider Demographics
NPI:1952808651
Name:THOMPSON, PHYLLIS (DNP FNP-C)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5406
Mailing Address - Country:US
Mailing Address - Phone:901-896-0739
Mailing Address - Fax:833-695-8358
Practice Address - Street 1:806 S COOPER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5406
Practice Address - Country:US
Practice Address - Phone:901-896-0739
Practice Address - Fax:833-695-8358
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905231363L00000X
ARA005681363L00000X
TNAPN0000024375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner