Provider Demographics
NPI:1285431270
Name:THOMPSON, JULIE THERESA (RDN, LD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:THERESA
Last Name:THOMPSON
Suffix:
Gender:
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W STOLP AVE
Mailing Address - Street 2:
Mailing Address - City:MEDICINE LODGE
Mailing Address - State:KS
Mailing Address - Zip Code:67104-1268
Mailing Address - Country:US
Mailing Address - Phone:620-213-2414
Mailing Address - Fax:
Practice Address - Street 1:308 W STOLP AVE
Practice Address - Street 2:
Practice Address - City:MEDICINE LODGE
Practice Address - State:KS
Practice Address - Zip Code:67104-1268
Practice Address - Country:US
Practice Address - Phone:620-213-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2987133V00000X
OK2158133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered