Provider Demographics
NPI:1639549629
Name:THOMPSON, BILLIE JOE
Entity Type:Individual
Prefix:MISS
First Name:BILLIE
Middle Name:JOE
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 1:611 STEVENSON ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-1428
Mailing Address - Country:US
Mailing Address - Phone:573-281-8840
Mailing Address - Fax:
Practice Address - Street 1:611 STEVENSON ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-1428
Practice Address - Country:US
Practice Address - Phone:573-281-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator