Individual
ELIZABETH THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
807 N MONTE VISTA ST, ADA, OK 74820-7711
(580) 332-8855
(580) 332-7374
Mailing address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-3286
(580) 925-2362
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
P-T0921
AR
363AM0700X
Medical Physician Assistant
Primary
2171
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2172
OK BOARD OF MEDICAL LICENSURE
OK
Enumeration date
01/21/2010
Last updated
11/19/2021
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