Provider Demographics
NPI:1922625854
Name:THOMPSON, MINDY (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14780 S 225TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-6332
Mailing Address - Country:US
Mailing Address - Phone:918-521-0144
Mailing Address - Fax:
Practice Address - Street 1:2501 S LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57109-4601
Practice Address - Country:US
Practice Address - Phone:605-250-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily