Provider Demographics
NPI:1467832857
Name:THOMPSON, NEDRA (BS)
Entity Type:Individual
Prefix:
First Name:NEDRA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:NEDRA
Other - Middle Name:RENEE
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:300 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-3909
Mailing Address - Country:US
Mailing Address - Phone:918-758-1930
Mailing Address - Fax:918-758-1920
Practice Address - Street 1:300 N MISSION ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-3909
Practice Address - Country:US
Practice Address - Phone:918-758-1930
Practice Address - Fax:918-758-1920
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT080598178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health