Healthcare Provider Details

I. General information

NPI: 1629996004
Provider Name (Legal Business Name): CRYSTAL NICHOLE THOMPSON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 S FIR ST
PINE BLUFF AR
71603-6806
US

IV. Provider business mailing address

4000 S FIR ST
PINE BLUFF AR
71603-6806
US

V. Phone/Fax

Practice location:
  • Phone: 870-209-6388
  • Fax:
Mailing address:
  • Phone: 870-209-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberAR017765801212
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: