Provider Demographics
NPI:1609438159
Name:THOMPSON, MAMIE ALICIA (RD)
Entity type:Individual
Prefix:MRS
First Name:MAMIE
Middle Name:ALICIA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NE 10TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5418
Mailing Address - Country:US
Mailing Address - Phone:405-271-4022
Mailing Address - Fax:405-271-3020
Practice Address - Street 1:800 NE 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5418
Practice Address - Country:US
Practice Address - Phone:405-271-4022
Practice Address - Fax:405-271-3020
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered