Provider Demographics
NPI:1477964898
Name:THOMPSON, KATRISE (MED)
Entity Type:Individual
Prefix:
First Name:KATRISE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:KARTRISE
Other - Middle Name:NICHELLE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:257 N CALDERWOOD ST # 239
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2111
Mailing Address - Country:US
Mailing Address - Phone:865-405-3564
Mailing Address - Fax:
Practice Address - Street 1:211 FOOTHILLS MALL DRIVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3770
Practice Address - Country:US
Practice Address - Phone:865-263-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health