Healthcare Provider Details

I. General information

NPI: 1245570555
Provider Name (Legal Business Name): PAMELA J THOMPSON LPN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927A BRIAR RIDGE RD
TUPELO MS
38804-5963
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-680-6250
  • Fax: 662-680-4350
Mailing address:
  • Phone: 662-286-9883
  • Fax: 662-286-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP317484
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: