Provider Demographics
NPI:1861027765
Name:THOMPSON, ANGELA TAYLOR (LPN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:TAYLOR
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 RAILROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-2049
Mailing Address - Country:US
Mailing Address - Phone:423-428-9192
Mailing Address - Fax:423-428-9281
Practice Address - Street 1:215 DAYTON MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1047
Practice Address - Country:US
Practice Address - Phone:423-428-9291
Practice Address - Fax:423-428-9281
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76148164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty