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General NPI Number Information
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NPI Number | 1104578418
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Entity Type | Individual
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Provider Name | FALLON THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 6161 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-1902
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Country | US
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Telephone | 918-502-1900
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Fax | 918-494-6303
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Provider Business Mailing Address
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Address Line | 211 E JUNEAU PL
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City | BROKEN ARROW
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State | OK
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Zip | 74012-8269
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Country | US
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Telephone | 918-289-3697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 215536
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R0136311
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License Number State | OK
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