1427453844 NPI number — DR. ANGELIA KAY TUCKER THOMPSON D.C.

Table of content: DR. ANGELIA KAY TUCKER THOMPSON D.C. (NPI 1427453844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427453844 NPI number — DR. ANGELIA KAY TUCKER THOMPSON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
ANGELIA
Provider Middle Name:
KAY TUCKER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
ANGELIA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427453844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 N 23RD ST STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAGOULD
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72450-3984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-537-0763
Provider Business Mailing Address Fax Number:
870-359-6094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 N 23RD ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAGOULD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72450-3984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-537-0763
Provider Business Practice Location Address Fax Number:
870-359-6094
Provider Enumeration Date:
10/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  16045 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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