Thacker-Thompson, Coralee M.

Thacker-Thompson, Coralee M. is an individual health care provider with primary practice located at 104 East Highway 60 , Mountain View MO 65548. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Thacker-Thompson, Coralee M. can be contacted via phone (417) 934-2251.

Contact Information

Primary practice address
104 East Highway 60 Mountain View MO 65548
Phone: (417) 934-2251
Fax: (417) 934-2871
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 045482 Missouri

Profile Details

NPI number 1780766618
LBN Legal business name Thacker-Thompson, Coralee M.
Credentials Pediatric Nurse Practitioner (PNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 19th, 2006
Last updated Jul 15th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780766618 NPPES
Missouri MEDICAID 426765103

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