Healthcare Provider Details

I. General information

NPI: 1659218154
Provider Name (Legal Business Name): KANDIS THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346761 E 810 RD
AGRA OK
74824-6359
US

IV. Provider business mailing address

346761 E 810 RD
AGRA OK
74824-6359
US

V. Phone/Fax

Practice location:
  • Phone: 775-934-4724
  • Fax:
Mailing address:
  • Phone: 775-934-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209627
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: