Provider Demographics
NPI:1518650050
Name:THOMPSON, DEDRA
Entity Type:Individual
Prefix:MRS
First Name:DEDRA
Middle Name:
Last Name:THOMPSON
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 1:7815 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4605
Mailing Address - Country:US
Mailing Address - Phone:501-471-8580
Mailing Address - Fax:
Practice Address - Street 1:7815 W 28TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-4605
Practice Address - Country:US
Practice Address - Phone:501-471-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X, 225800000X
AR3747P1801X, 385HR2060X, 106S00000X, 103K00000X, 106E00000X, 171000000X, 174H00000X, 221700000X, 252Y00000X, 332BC3200X, 222Q00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No171000000XOther Service ProvidersMilitary Health Care Provider
No174H00000XOther Service ProvidersHealth Educator
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No251C00000XAgenciesDay Training, Developmentally Disabled Services