Provider Demographics
NPI:1306975008
Name:THOMPSON, NETHA JAN (RN FNP-C)
Entity type:Individual
Prefix:MS
First Name:NETHA
Middle Name:JAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN FNP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1500 WILDBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-4316
Mailing Address - Country:US
Mailing Address - Phone:936-632-1628
Mailing Address - Fax:
Practice Address - Street 1:1807 W FRANK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5108
Practice Address - Country:US
Practice Address - Phone:936-634-1400
Practice Address - Fax:936-634-1406
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX602213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ57223Medicare UPIN