Provider Demographics
NPI:1265829071
Name:THOMPSON, MARIA (LPN/BAT/CPC/PRSS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN/BAT/CPC/PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2512
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-2512
Mailing Address - Country:US
Mailing Address - Phone:318-992-9238
Mailing Address - Fax:318-992-9162
Practice Address - Street 1:155 NINTH ST STE C
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-3900
Practice Address - Country:US
Practice Address - Phone:318-992-9238
Practice Address - Fax:318-992-9162
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0059076164W00000X
172V00000X, 247000000X, 247200000X
LA20192470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No172V00000XOther Service ProvidersCommunity Health Worker
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20192470OtherLOUISIANA BOARD OF NURSING
OK59076OtherOKLAHOMA NURSING LICENSE