Provider Demographics
NPI:1821029539
Name:THOMPSON, YVETTE L (DPM)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 LAUREL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2714
Mailing Address - Country:US
Mailing Address - Phone:757-377-0245
Mailing Address - Fax:904-236-4616
Practice Address - Street 1:1166 LAUREL VALLEY DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-2714
Practice Address - Country:US
Practice Address - Phone:757-377-0245
Practice Address - Fax:904-236-4616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300929213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA141169OtherSENTARA
VA306683OtherANTHEM
VAV05418Medicare UPIN
VA190001463Medicare PIN