Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | R886810 | MS |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R886810 | MS |
NPI | 1033585286 |
---|---|
Provider Name | Deidra Thompson |
First Address | Terry, MS 39170-9013 |
Second Address | Pearl, MS 39208-9008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2015 |
Last Update Date | 10/04/2019 |