Provider Demographics
NPI:1033816855
Name:THOMPSON, LYNNAE (RN)
Entity Type:Individual
Prefix:
First Name:LYNNAE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 JACOB CV
Mailing Address - Street 2:
Mailing Address - City:WARD
Mailing Address - State:AR
Mailing Address - Zip Code:72176-9633
Mailing Address - Country:US
Mailing Address - Phone:501-350-1235
Mailing Address - Fax:
Practice Address - Street 1:307 N ADAMS ST STE B
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2658
Practice Address - Country:US
Practice Address - Phone:501-394-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR096478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR096478OtherRN LICENSE