Provider Demographics
NPI:1013522333
Name:THOMPSON, DANELLA GO
Entity Type:Individual
Prefix:
First Name:DANELLA
Middle Name:GO
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 1:6204 COUNTY ROAD 707
Mailing Address - Street 2:
Mailing Address - City:ALVARADO
Mailing Address - State:TX
Mailing Address - Zip Code:76009-5970
Mailing Address - Country:US
Mailing Address - Phone:817-683-6952
Mailing Address - Fax:
Practice Address - Street 1:206 N PARKWAY DR
Practice Address - Street 2:
Practice Address - City:ALVARADO
Practice Address - State:TX
Practice Address - Zip Code:76009-3716
Practice Address - Country:US
Practice Address - Phone:817-502-3451
Practice Address - Fax:888-571-4035
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX416132501Medicaid