Provider Demographics
NPI:1982191615
Name:THOMPSON, ASHLEY SMITH
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SMITH
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 1:217 LAKE VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3615
Mailing Address - Country:US
Mailing Address - Phone:985-502-7198
Mailing Address - Fax:
Practice Address - Street 1:217 LAKE VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-3615
Practice Address - Country:US
Practice Address - Phone:985-502-7198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20140038164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse