Provider Demographics
NPI:1124484332
Name:THOMPSON, KEYUNDRA D
Entity type:Individual
Prefix:
First Name:KEYUNDRA
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5040
Mailing Address - Country:US
Mailing Address - Phone:870-464-1337
Mailing Address - Fax:870-464-1338
Practice Address - Street 1:702 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5040
Practice Address - Country:US
Practice Address - Phone:870-464-1337
Practice Address - Fax:870-464-1338
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARRBT-22-210369106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator