Provider Demographics
NPI:1467449876
Name:THOMPSON, KELLY (CNM FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNM FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 HOSPITAL DR
Practice Address - Street 2:SUITE 4A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5248
Practice Address - Country:US
Practice Address - Phone:828-650-8077
Practice Address - Fax:828-651-0194
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113835363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7002047Medicaid
NC15785OtherBCBS OF NC
NC7002047Medicaid