Healthcare Provider Details

I. General information

NPI: 1396703104
Provider Name (Legal Business Name): LINDA L THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5659 S REX RD
MEMPHIS TN
38119-3821
US

IV. Provider business mailing address

5659 S REX RD
MEMPHIS TN
38119-3821
US

V. Phone/Fax

Practice location:
  • Phone: 901-763-3636
  • Fax: 901-763-3694
Mailing address:
  • Phone: 901-763-3636
  • Fax: 901-763-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number8262
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: