Individual
CORALEE M. THACKER-THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
104 EAST HIGHWAY 60, MOUNTAIN VIEW, MO 65548
(417) 934-2251
(417) 934-2871
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
045482
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
426765103
—
MO
Enumeration date
10/19/2006
Last updated
07/15/2008
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