Healthcare Provider Details

I. General information

NPI: 1073163481
Provider Name (Legal Business Name): MRS. EVELYN JEAN THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 LAKEVIEW RD APT B3
NORTH LITTLE ROCK AR
72116-9384
US

IV. Provider business mailing address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 870-592-3122
  • Fax:
Mailing address:
  • Phone: 501-257-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: