Provider Demographics
NPI:1992781371
Name:THOMPSON, ANGELA LOUISE (RN)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LOUISE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 TAFT BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4020
Mailing Address - Country:US
Mailing Address - Phone:940-692-1493
Mailing Address - Fax:940-676-8005
Practice Address - Street 1:149 HART STREET
Practice Address - Street 2:82 MEDICAL GROUP/CREDENTIALS
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3482
Practice Address - Country:US
Practice Address - Phone:940-676-2004
Practice Address - Fax:940-767-8005
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001082404163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVAD 000Medicare UPIN