Healthcare Provider Details

I. General information

NPI: 1922625854
Provider Name (Legal Business Name): MINDY THOMPSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 S LOUIS AVE
SIOUX FALLS SD
57109-4601
US

IV. Provider business mailing address

14780 S 225TH EAST AVE
COWETA OK
74429-6332
US

V. Phone/Fax

Practice location:
  • Phone: 605-250-1200
  • Fax:
Mailing address:
  • Phone: 918-521-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75793
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: