MEDICARE: DREFUS EARL THOMPSON JR. APRN

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
1	363LA2200X	Adult Health Nurse Practitioner	1058536	TX
2	363LA2100X	Acute Care Nurse Practitioner	1058536	TX

General Provider Information

NPI Number	:	1336418490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DREFUS EARL THOMPSON JR. APRN

Provider Business Mailing Address
First Line	:	6711 LILACBROOK CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-4188
Country	:	US
Telephone Number	:	936-526-1315
Fax Number	:

Provider Business Practice Location Address
First Line	:	13300 HARGRAVE RD STE 390
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4374
Country	:	US
Telephone Number	:	281-737-8460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	10/19/2023

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