Stacy L Thompson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71004728A Issued in IN

Practice address

1520 N Senate Ave
Indianapolis, IN 46202-2213

Phone

(317) 962-8893

Fax

(317) 962-6722

NPI assigned

Oct 16, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Stacy Lynn Fetzer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390348800000",
    "number": "1063840759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "SUITE 130 - PROVIDER ENROLLMENT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N SENATE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022213",
            "telephone_number": "317-962-8893",
            "fax_number": "317-962-6722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "STACY",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-16",
        "last_updated": "2014-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "IN",
            "license": "28207962A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71004728A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201200500",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "FETZER",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samantha Thompson
• Sean M Thompson, MD
• Shannon L Thompson, MD
• Sharon Lynn Thompson, LMFT
• Sophia Grace Thompson
• Tanya K Thompson, LCSW
• Terence Terell Thompson Sr., NP
• Tiffany Lynette Thompson
• Tracy L Thompson, NP
• Tricia Thompson

• Family Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.