Healthcare Provider Details

I. General information

NPI: 1245973403
Provider Name (Legal Business Name): CODY THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4424
US

IV. Provider business mailing address

3215 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4424
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-1000
  • Fax:
Mailing address:
  • Phone: 479-463-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-19259
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: