Provider Demographics
NPI:1407048887
Name:THOMPSON, KRISTAN ANNE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KRISTAN
Middle Name:ANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CANAL ST
Mailing Address - Street 2:SUITE 502 AND 503
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4153
Mailing Address - Country:US
Mailing Address - Phone:912-450-8000
Mailing Address - Fax:912-450-8001
Practice Address - Street 1:114 CANAL ST
Practice Address - Street 2:SUITE 502 AND 503
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4153
Practice Address - Country:US
Practice Address - Phone:912-450-8000
Practice Address - Fax:912-450-8001
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN159396363LF0000X, 163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse