Healthcare Provider Details

I. General information

NPI: 1598042525
Provider Name (Legal Business Name): EMILY THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 HIGHWAY 51 N
BROOKHAVEN MS
39601-2350
US

IV. Provider business mailing address

PO BOX 3864
BROOKHAVEN MS
39603-7864
US

V. Phone/Fax

Practice location:
  • Phone: 601-835-9444
  • Fax: 601-833-5210
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR880210
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: