Healthcare Provider Details

I. General information

NPI: 1235586371
Provider Name (Legal Business Name): COURTNEY THOMPSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 SOUTHWEST BLVD
TULSA OK
74107-2705
US

IV. Provider business mailing address

5310 E 31ST ST FL 13
TULSA OK
74135-5018
US

V. Phone/Fax

Practice location:
  • Phone: 918-561-1131
  • Fax: 918-561-1140
Mailing address:
  • Phone: 918-561-5701
  • Fax: 918-561-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number7793
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: