Provider Demographics
NPI:1871544387
Name:THOMPSON, LADONNA LYNN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LADONNA
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5139
Mailing Address - Country:US
Mailing Address - Phone:903-247-4404
Mailing Address - Fax:903-247-4408
Practice Address - Street 1:3100 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5139
Practice Address - Country:US
Practice Address - Phone:903-247-4404
Practice Address - Fax:903-247-4408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03444363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03444OtherSTATE LICENSE
TX30138854OtherDPS DRUG LICENSE
TXMT1227291OtherDEA DRUG LICENSE
TXP83753Medicare UPIN