Provider Demographics
NPI:1205020591
Name:THOMPSON, KRISTY MARIE (DO)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:KRISTY
Other - Middle Name:MARIE
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:17432 STATE ROUTE 9 SE STE 201
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296
Practice Address - Country:US
Practice Address - Phone:425-404-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1205020591Medicaid