Provider Demographics
NPI:1306211156
Name:THOMPSON, KELLEY PRIVETT (RN, MSN, AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:PRIVETT
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN, MSN, AGNP-C
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Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:704-874-0707
Practice Address - Street 1:1875 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7413
Practice Address - Country:US
Practice Address - Phone:704-874-0600
Practice Address - Fax:704-865-4785
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2019-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0992043-NP363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health