MEDICARE: ELIZABETH THOMPSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2172	OK
2	363A00000X	Physician Assistant	PA-406	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2172	OTHER	OK	OK BOARD OF MEDICAL LICENSURE

General Provider Information

NPI Number	:	1427389097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH THOMPSON PA

Provider Business Mailing Address
First Line	:	527 W 3RD ST
Second Line	:
City	:	KONAWA
State	:	OK
Zip	:	74849-1415
Country	:	US
Telephone Number	:	580-925-3286
Fax Number	:	580-925-2362

Provider Business Practice Location Address
First Line	:	807 N MONTE VISTA ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-7711
Country	:	US
Telephone Number	:	580-332-8855
Fax Number	:	580-332-7374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	06/01/2026

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Directions to “ ELIZABETH THOMPSON PA” Practice Location

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