MEDICARE: CAROLYN DENICE THOMPSON APRN-CNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1126573	TX

General Provider Information

NPI Number	:	1962188219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN DENICE THOMPSON APRN-CNP

Provider Business Mailing Address
First Line	:	4013 BEACON POINTE LN
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-8399
Country	:	US
Telephone Number	:	832-382-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 FM 517 RD W STE 222
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-3924
Country	:	US
Telephone Number	:	346-399-9241
Fax Number	:

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

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	08/28/2024

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