Provider Demographics
NPI:1124057443
Name:THOMPSON, KEALANALANI R (MD)
Entity type:Individual
Prefix:
First Name:KEALANALANI
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KEALANALANI
Other - Middle Name:R
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 N RAINBOW BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1082
Mailing Address - Country:US
Mailing Address - Phone:702-259-1228
Mailing Address - Fax:702-259-1252
Practice Address - Street 1:500 N RAINBOW BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1082
Practice Address - Country:US
Practice Address - Phone:702-259-1228
Practice Address - Fax:702-259-1252
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12769207P00000X
NV12506207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55426301Medicaid
HI55426301Medicaid
HI56932Medicare ID - Type Unspecified