Provider Demographics
NPI:1972121515
Name:THOMPSON, TAMIKA D
Entity type:Individual
Prefix:
First Name:TAMIKA
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 1:311 DRY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4102
Mailing Address - Country:US
Mailing Address - Phone:314-285-9356
Mailing Address - Fax:636-685-0232
Practice Address - Street 1:311 DRY BROOK RD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4102
Practice Address - Country:US
Practice Address - Phone:314-285-9356
Practice Address - Fax:636-685-0232
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide