Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 3950-17 | MS |
N | 213EG0000X | General Practice | 3950-17 | MS |
Y | 1223G0001X | General Practice | 6573-C1 | AL |
Y | 213EG0000X | General Practice | 6573-C1 | AL |
NPI | 1003337775 |
---|---|
Provider Name | Dr. Niketa Arlene Thompson |
First Address | Mobile, AL 36608-3134 |
Second Address | Mobile, AL 36608-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 24/09/2020 |