Provider Demographics
NPI:1992715874
Name:THOMPSON, SANDRA CHARLENE (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CHARLENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WILLIAMS ENTERPRISE DR.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506
Mailing Address - Country:US
Mailing Address - Phone:931-526-1050
Mailing Address - Fax:931-526-8163
Practice Address - Street 1:3300 WILLIAMS ENTERPRISE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506
Practice Address - Country:US
Practice Address - Phone:931-528-9222
Practice Address - Fax:931-854-0907
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3154952OtherBLUE CROSS BLUE SHEILD TN
TN3154952OtherBLUE CROSS BLUE SHEILD TN
TN3154952OtherBLUE CROSS BLUE SHEILD TN
TNP11490Medicare UPIN