=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508749086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANDY KAY THOMPSON SCHOOL PSYCHOLOGIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2025
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10532 N 117TH EAST AVE
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-6697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-500-3488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10532 N 117TH EAST AVE
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-6697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-500-3488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 412796
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------