Provider Demographics
NPI:1467791848
Name:THOMPSON, ELISA CLUPPER (NP-C)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:CLUPPER
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 NE 13TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5030
Mailing Address - Country:US
Mailing Address - Phone:405-235-0040
Mailing Address - Fax:405-235-4495
Practice Address - Street 1:750 NE 13TH ST FL 3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5030
Practice Address - Country:US
Practice Address - Phone:405-235-0040
Practice Address - Fax:405-235-4495
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK82995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner