Provider Demographics
NPI:1639053093
Name:THOMPSON, MICHAELA (RN)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 N BRUSH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7071
Mailing Address - Country:US
Mailing Address - Phone:479-544-5777
Mailing Address - Fax:
Practice Address - Street 1:3 E APPLEBY RD STE 301
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3160
Practice Address - Country:US
Practice Address - Phone:479-404-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR227059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine