Provider Demographics
NPI:1982565123
Name:THOMPSON, TA'LARA REGINA
Entity type:Individual
Prefix:
First Name:TA'LARA
Middle Name:REGINA
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 1:3849 KLAHANIE DR SE APT 4-204
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5849
Mailing Address - Country:US
Mailing Address - Phone:425-571-9202
Mailing Address - Fax:
Practice Address - Street 1:3849 KLAHANIE DR SE APT 4-204
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98029-5849
Practice Address - Country:US
Practice Address - Phone:425-571-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.61394050253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care