Provider Demographics
NPI:1447640578
Name:THOMPSON, ANDREA L (APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:5448 RENO CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2620
Mailing Address - Country:US
Mailing Address - Phone:775-993-9292
Mailing Address - Fax:775-993-9293
Practice Address - Street 1:5448 RENO CORPORATE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2620
Practice Address - Country:US
Practice Address - Phone:775-993-9292
Practice Address - Fax:775-993-9293
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002402363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1447640578Medicaid
13506348OtherCAQH