Provider Demographics
NPI:1356805956
Name:THOMPSON, BERYL (APRN, FNP)
Entity type:Individual
Prefix:
First Name:BERYL
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:MT ENTERPRISE
Mailing Address - State:TX
Mailing Address - Zip Code:75681-0489
Mailing Address - Country:US
Mailing Address - Phone:903-822-3076
Mailing Address - Fax:866-305-8303
Practice Address - Street 1:4002 S LOOP 256 STE K
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8402
Practice Address - Country:US
Practice Address - Phone:903-729-3015
Practice Address - Fax:877-547-2231
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily