Provider Demographics
NPI:1487334116
Name:THOMPSON, BETTY JO
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JO
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 1:7422 S LEWIS AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6819
Mailing Address - Country:US
Mailing Address - Phone:865-282-1785
Mailing Address - Fax:
Practice Address - Street 1:7422 S LEWIS AVE APT 4D
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6819
Practice Address - Country:US
Practice Address - Phone:865-282-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator