Provider Demographics
NPI:1396410973
Name:THOMPSON, STEPHANIE LAGALE (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAGALE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 MCDANIEL
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-9705
Mailing Address - Country:US
Mailing Address - Phone:931-217-8644
Mailing Address - Fax:
Practice Address - Street 1:3353 MCDANIEL
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-9705
Practice Address - Country:US
Practice Address - Phone:931-217-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0119766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty