Provider Demographics
NPI:1093115206
Name:THOMPSON, KATIE (DNP, ARNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:WETSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:818 5TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1303
Mailing Address - Country:US
Mailing Address - Phone:877-811-7526
Mailing Address - Fax:515-280-9525
Practice Address - Street 1:3303 109TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:877-811-7526
Practice Address - Fax:515-280-7526
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113217363L00000X
IAA121417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner