Active NPI
Tyanna Lee Thompson
- Community Health Worker
- Walton, NE
National Provider Identifier
1750198164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 21764579
- Practice address
- 4950 S 112TH St
Walton, NE 68461-9579 - Phone
- (531) 510-6945
- NPI assigned
- Dec 18, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 21764579 | NE | Primary |
Addresses
Primary practice location
4950 S 112TH St
Walton, NE 68461-9579
Mailing address
1938 Garfield St
Lincoln, NE 68502
Phone (531) 519-6945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21764579 | NE | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734480000000",
"number": "1750198164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1938 GARFIELD ST",
"city": "LINCOLN",
"state": "NE",
"postal_code": "68502",
"telephone_number": "531-519-6945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4950 S 112TH ST",
"city": "WALTON",
"state": "NE",
"postal_code": "684619579",
"telephone_number": "531-510-6945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "TYANNA",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-18",
"last_updated": "2024-12-18",
"certification_date": "2024-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NE",
"license": "21764579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walton, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.