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Individual

LISA HICKS THOMPSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
2700 VISSING PARK RD, JEFFERSONVILLE, IN 47130-5989
(812) 246-9809
(770) 573-9513
Mailing address
2476 CANTON RD, MARIETTA, GA 30066-5377
(812) 246-9809
(770) 573-9513

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001505A
IN
363A00000X
Physician Assistant
PA03855
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
190024301
TX
05
190024302
TX
05
190024303
TX
05
300011148
IN
Enumeration date
10/10/2006
Last updated
10/19/2021
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