Individual
DEIDRA THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3794 HIGHWAY 468 W, PEARL, MS 39208-9008
(601) 932-2880
Mailing address
1783 JONES LOOP, TERRY, MS 39170-9013
(601) 613-5217
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R886810
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R886810
MS
Other
Enumeration date
08/11/2015
Last updated
04/10/2019
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