Provider Demographics
NPI:1699212100
Name:THOMPSON, EMILY (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4351
Mailing Address - Country:US
Mailing Address - Phone:817-522-1530
Mailing Address - Fax:817-523-8667
Practice Address - Street 1:1305 W MAGNOLIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4351
Practice Address - Country:US
Practice Address - Phone:817-522-1530
Practice Address - Fax:817-523-8667
Is Sole Proprietor?:No
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132813363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology