Samuel Thompson
Individual provider Active NPI Certified Registered Nurse Anesthetist · Decatur, MS
NPI 1407736796 · NPPES record last updated Jul 6, 2026
Key facts
- NPI
- 1407736796
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 95002903 (CA)
- Practice address
- 535 Scanlan Rd
Decatur, MS 39327-9313 - Phone
- (601) 513-7545
- NPI assigned
- Sep 5, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 913239 | MS | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 95002903 | CA | Yes |
Addresses
Primary practice location
535 Scanlan Rd
Decatur, MS 39327-9313
Mailing address
535 Scanlan Rd
Decatur, MS 39327-9313
Other providers in Decatur, MS
- Amber Lynn Scoggin
- Kalena Yolanda Smith
- Stillwaters Counseling
- Jackson Randall Therrien
- Emily Boggan Thompson
- Kelsey Necole Windham
All providers in Decatur, MS · Certified Registered Nurse Anesthetist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.