Healthcare Provider Details

I. General information

NPI: 1992627657
Provider Name (Legal Business Name): HEATHER DAWN THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 MARVIN SHIELDS BLVD BLDG. 472, NORTH WING, 2ND FL., RM. 2052
GULFPORT MS
39501
US

IV. Provider business mailing address

252 GARFIELD AVE
BILOXI MS
39531-3342
US

V. Phone/Fax

Practice location:
  • Phone: 228-822-5710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: