Provider Demographics
NPI:1922095710
Name:THOMPSON, REBA FLOIS (RD)
Entity Type:Individual
Prefix:
First Name:REBA
Middle Name:FLOIS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21815 CINDY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-9058
Mailing Address - Country:US
Mailing Address - Phone:479-466-6272
Mailing Address - Fax:479-587-5949
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:479-444-5043
Practice Address - Fax:479-587-5949
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
OK1324133V00000X
AR528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
5W884Medicare UPIN