MEDICARE: MACAYLA 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
1	163W00000X	Registered Nurse	989677	TX

General Provider Information

NPI Number	:	1407471196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACAYLA THOMPSON

Provider Business Mailing Address
First Line	:	120 MAIN ST UNIT 2311
Second Line	:
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-3338
Country	:	US
Telephone Number	:	951-403-0546
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 MAIN ST UNIT 2311
Second Line	:
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-3338
Country	:	US
Telephone Number	:	951-403-0546
Fax Number	:

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

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	06/09/2020

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Directions to “ MACAYLA THOMPSON ” Practice Location

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