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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780766618 | NPPES |
| Missouri | MEDICAID | 426765103 |
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