Provider Demographics
NPI:1295475333
Name:THOMPSON, DUSTY ELLEN
Entity type:Individual
Prefix:
First Name:DUSTY
Middle Name:ELLEN
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 1:9998 E GREASY BEND RD
Mailing Address - Street 2:
Mailing Address - City:STRINGTOWN
Mailing Address - State:OK
Mailing Address - Zip Code:74569-2046
Mailing Address - Country:US
Mailing Address - Phone:580-239-2001
Mailing Address - Fax:
Practice Address - Street 1:263 E COURT ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2016
Practice Address - Country:US
Practice Address - Phone:580-889-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach