Provider Demographics
NPI:1063118180
Name:THOMPSON, KELLY J
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
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 1:2470 WARREN PKWY APT 18
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-1364
Mailing Address - Country:US
Mailing Address - Phone:330-687-8852
Mailing Address - Fax:
Practice Address - Street 1:2470 WARREN PKWY APT 18
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-1364
Practice Address - Country:US
Practice Address - Phone:330-687-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide