Individual ProviderDesirea' ThompsonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address200 Hawthorne Ln, Charlotte, NC 28204-2515(704) 384-4000(704) 338-2208PECOS EnrollmentBased on the most recent information from CMS, provider Desirea' Thompson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:59 PM.Profile DetailsProvider ID1194618025Provider TypeIndividualFull NameThompson, Desirea'CredentialNPGenderFemaleSole ProprietorNoEnumeration Date5/30/2025Last Updated5/30/2025Contact InformationPractice LocationPractice Address200 Hawthorne Ln, Charlotte, NC 28204-2515Phone(704) 384-4000FaxUnlisted FaxMailing LocationMailing Address4110 Double Creek Crossing Dr Apt 122, Charlotte, NC 28269-3232Phone(704) 338-2208FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense5022261North Carolina