Provider Demographics
NPI:1992770853
Name:THOMPSON, SUSAN M (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6337
Mailing Address - Country:US
Mailing Address - Phone:405-360-2827
Mailing Address - Fax:866-415-9895
Practice Address - Street 1:2417 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6337
Practice Address - Country:US
Practice Address - Phone:405-360-2827
Practice Address - Fax:866-415-9895
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0030789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100211320AMedicaid
OK24M802411Medicare PIN
S67738Medicare UPIN
OK100211320AMedicaid