1972331775 NPI number — MRS. NATALIE ASHTON THOMPSON LPTA

Table of content: MRS. NATALIE ASHTON THOMPSON LPTA (NPI 1972331775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972331775 NPI number — MRS. NATALIE ASHTON THOMPSON LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
NATALIE
Provider Middle Name:
ASHTON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972331775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 MAIN ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39654-3702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-587-2563
Provider Business Mailing Address Fax Number:
601-587-0472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 BROOKWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39601-3266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-833-7317
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2024

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: 225200000X , with the licence number:  PTA-7822 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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