Provider Demographics
NPI:1922699917
Name:THOMPSON, DEMESHA
Entity Type:Individual
Prefix:
First Name:DEMESHA
Middle Name:
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 1:1506 REALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2447
Mailing Address - Country:US
Mailing Address - Phone:163-624-9048
Mailing Address - Fax:636-249-0483
Practice Address - Street 1:1506 REALE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2447
Practice Address - Country:US
Practice Address - Phone:163-624-9048
Practice Address - Fax:636-249-0483
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider