Provider Demographics
NPI:1285234096
Name:THOMPSON, BRIAN (FNP-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18051 RIVER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7093
Mailing Address - Country:US
Mailing Address - Phone:317-207-6112
Mailing Address - Fax:
Practice Address - Street 1:18051 RIVER RD STE 102
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7093
Practice Address - Country:US
Practice Address - Phone:317-207-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28221871A363LF0000X
IN71010523A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily