Provider Demographics
NPI:1891826806
Name:THOMPSON, AMY KATHERINE (ARNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 N SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8699
Mailing Address - Country:US
Mailing Address - Phone:208-635-5623
Mailing Address - Fax:208-601-6153
Practice Address - Street 1:6360 N SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8699
Practice Address - Country:US
Practice Address - Phone:208-635-5623
Practice Address - Fax:208-601-6153
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007670363L00000X, 363LA2100X, 363LF0000X
IDNP-1674A363LA2100X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCS40830OtherID BOARD OF PHARMACY
IDNP-1674AOtherIDAHO
WAP00450009OtherRAILROAD MEDICARE
WA0946290001Medicare NSC