Provider Demographics
NPI:1235532656
Name:THOMPSON, ALLYSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 COUNTY ROAD 174 E
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:TX
Mailing Address - Zip Code:75684-9579
Mailing Address - Country:US
Mailing Address - Phone:903-720-0609
Mailing Address - Fax:
Practice Address - Street 1:401 E LANTRIP ST
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-5956
Practice Address - Country:US
Practice Address - Phone:903-983-0081
Practice Address - Fax:903-983-0082
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126502363L00000X
TX126502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340888201Medicaid
TX75-2616977-017OtherTRICARE
TX8221NLOtherBCBS
TX75-2616977-017OtherTRICARE
TX340888201Medicaid