Provider Demographics
NPI:1134822166
Name:THOMPSON, AUDREY KATHLEEN (RN, IBCLC, CCE)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:KATHLEEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN, IBCLC, CCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 BROWNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-3233
Mailing Address - Country:US
Mailing Address - Phone:404-956-4715
Mailing Address - Fax:
Practice Address - Street 1:1035 BROWNSTONE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-3233
Practice Address - Country:US
Practice Address - Phone:404-956-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169699163WN0003X, 163WH0200X, 163WL0100X, 163WM0102X, 163WN0002X, 163WG0000X, 163WC0400X, 163WC1500X, 163WC1600X, 163WX0003X, 163WN1003X, 163WP0200X, 163WP0808X, 163WX0002X, 163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk