Provider Demographics
NPI:1447536073
Name:THOMPSON, ANITA (CNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:800 PIKE ST STE 2
Practice Address - Street 2:PHYSICIANS CARE EXPRESS
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3507
Practice Address - Country:US
Practice Address - Phone:740-373-3960
Practice Address - Fax:740-373-3965
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12846NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056026Medicaid
OH0056026Medicaid
OHP01428846OtherRAILROAD MEDICARE MHCPI