Healthcare Provider Details

I. General information

NPI: 1043590722
Provider Name (Legal Business Name): ALICIA THOMPSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 02/07/2021
Certification Date: 02/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 SALEM CREEK RD
EDMOND OK
73013-2455
US

IV. Provider business mailing address

15005 SALEM CREEK RD
EDMOND OK
73013-2455
US

V. Phone/Fax

Practice location:
  • Phone: 405-657-4537
  • Fax: 405-347-7617
Mailing address:
  • Phone: 405-657-4537
  • Fax: 405-347-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25776
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICIA D THOMPSON
Title or Position: OWNER
Credential: MD
Phone: 405-657-4537