Provider Demographics
NPI:1881455822
Name:THOMPSON, CHASITY DAWN
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:DAWN
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 876
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-0876
Mailing Address - Country:US
Mailing Address - Phone:304-543-0128
Mailing Address - Fax:
Practice Address - Street 1:1408 BUCKNER RD
Practice Address - Street 2:
Practice Address - City:TORNADO
Practice Address - State:WV
Practice Address - Zip Code:25202-8018
Practice Address - Country:US
Practice Address - Phone:304-543-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant