Healthcare Provider Details

I. General information

NPI: 1245967348
Provider Name (Legal Business Name): MIKA THOMPSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 HIGHWAY 165 S
OAKDALE LA
71463-5098
US

IV. Provider business mailing address

2668 HIGHWAY 165 S
OAKDALE LA
71463-4904
US

V. Phone/Fax

Practice location:
  • Phone: 318-215-7806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227048
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: