Provider Demographics
NPI:1770244675
Name:THOMPSON, RONDA MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:MICHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9293 E TURKEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-7476
Mailing Address - Country:US
Mailing Address - Phone:580-364-3185
Mailing Address - Fax:
Practice Address - Street 1:1308 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5236
Practice Address - Country:US
Practice Address - Phone:918-423-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK206374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine