Provider Demographics
NPI:1508026964
Name:THOMPSON-POTTS, AVA
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:THOMPSON-POTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7772 E JACK OAK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-6110
Mailing Address - Country:US
Mailing Address - Phone:520-777-6491
Mailing Address - Fax:
Practice Address - Street 1:7772 E JACK OAK RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-6110
Practice Address - Country:US
Practice Address - Phone:520-777-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ486226385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child