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NPI Code Detail

MEDICARE: NIKITA MARIE THOMPSON

MEDICARE: NIKITA MARIE THOMPSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker9952TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003538117
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKITA MARIE THOMPSON
Provider Business Mailing Address
First Line : PO BOX 699
Second Line :
City : MOUNTAIN HOME
State : TN
Zip : 37684-0699
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 917 W WALNUT ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6527
Country : US
Telephone Number : 423-439-6464
Fax Number : 423-439-7118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2022
Last Update Date : 12/18/2025

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Directions to “ NIKITA MARIE THOMPSON ” Practice Location

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