Healthcare Provider Details

I. General information

NPI: 1427984905
Provider Name (Legal Business Name): MS. ELISE K THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 UNITED FOUNDERS BLVD STE 100G
OKLAHOMA CITY OK
73112-4290
US

IV. Provider business mailing address

3000 UNITED FOUNDERS BLVD STE 100G
OKLAHOMA CITY OK
73112-4290
US

V. Phone/Fax

Practice location:
  • Phone: 405-977-9671
  • Fax: 405-518-8007
Mailing address:
  • Phone: 405-977-9671
  • Fax: 405-518-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: