Provider Demographics
NPI:1548760259
Name:THOMPSON, TYTHIA RENEE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TYTHIA
Middle Name:RENEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5254
Mailing Address - Country:US
Mailing Address - Phone:936-899-1383
Mailing Address - Fax:
Practice Address - Street 1:737 JACKSON RD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5254
Practice Address - Country:US
Practice Address - Phone:936-899-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX868813163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse