Provider Demographics
NPI:1609384197
Name:THOMPSON, PANCHANOK CHUMPUMUD (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:PANCHANOK
Middle Name:CHUMPUMUD
Last Name:THOMPSON
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 INTERNATIONAL PKWY STE 1010
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8346
Mailing Address - Country:US
Mailing Address - Phone:972-267-1988
Mailing Address - Fax:
Practice Address - Street 1:6404 INTERNATIONAL PKWY STE 1010
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8346
Practice Address - Country:US
Practice Address - Phone:972-267-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135936363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty