Provider Demographics
NPI:1043450745
Name:THOMPSON, KATHLEEN RAE (R,N,)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:R,N,
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:RAE
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1000 HEALTH CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:SD
Mailing Address - Zip Code:57752-0540
Mailing Address - Country:US
Mailing Address - Phone:605-455-2451
Mailing Address - Fax:605-455-2808
Practice Address - Street 1:1000 HEALTH CENTER ROAD
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:SD
Practice Address - Zip Code:57752-0540
Practice Address - Country:US
Practice Address - Phone:605-455-2451
Practice Address - Fax:605-455-2808
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR037279163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health