Provider Demographics
NPI:1063548923
Name:THOMPSON, DARREL W (RN 12088NP)
Entity type:Individual
Prefix:PROF
First Name:DARREL
Middle Name:W
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RN 12088NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLLEGE STATION DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-5100
Mailing Address - Country:US
Mailing Address - Phone:478-471-2783
Mailing Address - Fax:
Practice Address - Street 1:100 COLLEGE STATION DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-5100
Practice Address - Country:US
Practice Address - Phone:478-471-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 12088NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner