Provider Demographics
NPI:1326264979
Name:THOMPSON, SHAWN (CFA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 CUB RUN HWY
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-8194
Mailing Address - Country:US
Mailing Address - Phone:270-524-9034
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:3170 CUB RUN HWY
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-8194
Practice Address - Country:US
Practice Address - Phone:270-524-9034
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist