Provider Demographics
NPI:1467106047
Name:THOMPSON, KATIE ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ELAINE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1285 HEMBREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5715
Mailing Address - Country:US
Mailing Address - Phone:770-442-1050
Mailing Address - Fax:770-475-1621
Practice Address - Street 1:1285 HEMBREE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5715
Practice Address - Country:US
Practice Address - Phone:770-442-1050
Practice Address - Fax:770-475-1621
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN215315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily