Provider Demographics
NPI:1053321596
Name:THOMPSON, ALICIA D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 ASTORIA WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5997
Mailing Address - Country:US
Mailing Address - Phone:253-343-0116
Mailing Address - Fax:417-350-1935
Practice Address - Street 1:2908 ASTORIA WAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5997
Practice Address - Country:US
Practice Address - Phone:253-343-0116
Practice Address - Fax:480-383-6454
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK257762084P0800X, 2084P0804X
SC869082084P0800X
MOMO1083262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203954334Medicaid
OK100125890AMedicaid
MO091050022Medicare ID - Type Unspecified