Provider Demographics
NPI:1386295079
Name:THOMPSON, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
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 1:520 COUNTY ROAD 4485 # 760
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:TX
Mailing Address - Zip Code:77664-6578
Mailing Address - Country:US
Mailing Address - Phone:409-617-9258
Mailing Address - Fax:
Practice Address - Street 1:520 COUNTY ROAD 4485
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:TX
Practice Address - Zip Code:77664-6578
Practice Address - Country:US
Practice Address - Phone:409-617-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider