=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235532656
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLYSON THOMPSON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2014
-----------------------------------------------------
Last Update Date | 03/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 E LANTRIP ST
-----------------------------------------------------
City | KILGORE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75662-5956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-983-0081
-----------------------------------------------------
Fax | 903-983-0082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1261 COUNTY ROAD 174 E
-----------------------------------------------------
City | OVERTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75684-9579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-720-0609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP126502
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 126502
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------