Provider Demographics
NPI:1407142888
Name:THOMPSON, KATHLEEN (CRNP-F)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CRNP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 CALVERT CLIFFS PKWY
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-4700
Mailing Address - Country:US
Mailing Address - Phone:301-404-7838
Mailing Address - Fax:
Practice Address - Street 1:1650 CALVERT CLIFFS PKWY
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-4700
Practice Address - Country:US
Practice Address - Phone:301-404-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily