Provider Demographics
NPI:1447682612
Name:THOMPSON, ROSALIND
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-1191
Mailing Address - Country:US
Mailing Address - Phone:972-803-5417
Mailing Address - Fax:972-863-8121
Practice Address - Street 1:9138 CHIMNEY CORNER LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2020
Practice Address - Country:US
Practice Address - Phone:972-803-5417
Practice Address - Fax:972-863-8121
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1209Medicaid
TX1209Medicaid