Provider Demographics
NPI:1356818058
Name:THOMPSON, TERRIE B (BSN, RN)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:B
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:TERRIE
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:300 CHAMPIONS DR APT 1205
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7258
Mailing Address - Country:US
Mailing Address - Phone:214-762-1227
Mailing Address - Fax:
Practice Address - Street 1:300 CHAMPIONS DR APT 1205
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7258
Practice Address - Country:US
Practice Address - Phone:214-762-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244264163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice