Provider Demographics
NPI:1790336808
Name:THOMPSON, YEVONNE WALKER
Entity Type:Individual
Prefix:
First Name:YEVONNE
Middle Name:WALKER
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:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:HEATH SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29058-0581
Mailing Address - Country:US
Mailing Address - Phone:803-577-4335
Mailing Address - Fax:
Practice Address - Street 1:419 DEPOT DR.
Practice Address - Street 2:
Practice Address - City:HEATH SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29058-2905
Practice Address - Country:US
Practice Address - Phone:803-577-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management