Healthcare Provider Details

I. General information

NPI: 1902542848
Provider Name (Legal Business Name): ASHLEY MEGAN THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARTIN LUTHER KING DR
MARKS MS
38646-1832
US

IV. Provider business mailing address

545 DEER RUN RD
BATESVILLE MS
38606-8655
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-3502
  • Fax:
Mailing address:
  • Phone: 662-619-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR879071
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905354
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: