Provider Demographics
NPI:1992132617
Name:THOMPSON, TERESA ANN (BSN, RN, CCM)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BSN, RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 CHEYENNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:214-642-5457
Mailing Address - Fax:
Practice Address - Street 1:1204 CHEYENNE DRIVE
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:214-642-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657696171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator