Healthcare Provider Details

I. General information

NPI: 1649798596
Provider Name (Legal Business Name): RAESHETTA N THOMPSON HAIR REPLACEMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 INDIAN TRL STE 101N
HARKER HEIGHTS TX
76548-7201
US

IV. Provider business mailing address

331 INDIAN TRL STE 101N
HARKER HEIGHTS TX
76548-7201
US

V. Phone/Fax

Practice location:
  • Phone: 866-631-0210
  • Fax:
Mailing address:
  • Phone: 214-603-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: