1033342993 NPI number — MS. LUANN KAY THOMPSON BSW

Table of content: MS. LUANN KAY THOMPSON BSW (NPI 1033342993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033342993 NPI number — MS. LUANN KAY THOMPSON BSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
LUANN
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BSW
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:
1033342993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 CHANDLER ST
Provider Second Line Business Mailing Address:
APT. 312
Provider Business Mailing Address City Name:
CAPE CANAVERAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32920-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-794-3918
Provider Business Mailing Address Fax Number:
321-610-8880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1861 S PATRICK DR
Provider Second Line Business Practice Location Address:
BOX 166
Provider Business Practice Location Address City Name:
INDIAN HARBOUR BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32937-4377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-610-8880
Provider Business Practice Location Address Fax Number:
321-610-8880
Provider Enumeration Date:
08/26/2009

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 764145100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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