Healthcare Provider Details

I. General information

NPI: 1760105340
Provider Name (Legal Business Name): NIKKI LEANN THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 MOUNT PLEASANT RD
HERNANDO MS
38632-1909
US

IV. Provider business mailing address

14315 HARRISON DR
BYHALIA MS
38611-7333
US

V. Phone/Fax

Practice location:
  • Phone: 662-429-5327
  • Fax:
Mailing address:
  • Phone: 662-501-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-100734
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: