Provider Demographics
NPI:1407144033
Name:THOMPSON, ANN ARMISTEAD (RD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:ARMISTEAD
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 INDIANA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5738
Mailing Address - Country:US
Mailing Address - Phone:806-788-1546
Mailing Address - Fax:
Practice Address - Street 1:6309 INDIANA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5738
Practice Address - Country:US
Practice Address - Phone:806-788-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345601OtherAMERICAN DIETETIC ASSOCIATION
TXDT00609OtherTX LICENSE