Healthcare Provider Details

I. General information

NPI: 1144183427
Provider Name (Legal Business Name): ELIZABETH NICOLE 'NIKKI' THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 RICE ROAD EXT STE 110
MATTHEWS NC
28105-4171
US

IV. Provider business mailing address

1905 #110 RICE ROAD EXTENSION
MATTHEWS NC
28105-4171
US

V. Phone/Fax

Practice location:
  • Phone: 704-845-1533
  • Fax:
Mailing address:
  • Phone: 704-845-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberNA
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: