Provider Demographics
NPI:1013125293
Name:THOMPSON, TAMMY L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:HICKORY FLAT
Mailing Address - State:MS
Mailing Address - Zip Code:38633-9500
Mailing Address - Country:US
Mailing Address - Phone:662-988-3865
Mailing Address - Fax:
Practice Address - Street 1:1436 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:HICKORY FLAT
Practice Address - State:MS
Practice Address - Zip Code:38633-9500
Practice Address - Country:US
Practice Address - Phone:662-988-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP303875164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770233Medicaid