Provider Demographics
NPI:1962194530
Name:THOMPSON, TATUM MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:MARIE
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 1:5248 OCEAN BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1361
Mailing Address - Country:US
Mailing Address - Phone:619-952-2985
Mailing Address - Fax:
Practice Address - Street 1:107 SHULT DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3009
Practice Address - Country:US
Practice Address - Phone:979-732-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant