Provider Demographics
NPI:1811432792
Name:THOMPSON, NAFEESAH (APRN)
Entity type:Individual
Prefix:
First Name:NAFEESAH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NAFEESAH
Other - Middle Name:A
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6800 NW 39TH EXPY
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2513
Mailing Address - Country:US
Mailing Address - Phone:405-789-6711
Mailing Address - Fax:405-440-6716
Practice Address - Street 1:6800 NW 39TH EXPY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2513
Practice Address - Country:US
Practice Address - Phone:405-789-6711
Practice Address - Fax:405-440-6750
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily