Provider Demographics
NPI:1487689667
Name:THOMPSON, STANLEY KENNETH (CRNA)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:KENNETH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CRNA
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 2329
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-7329
Mailing Address - Country:US
Mailing Address - Phone:360-336-6517
Mailing Address - Fax:360-466-2682
Practice Address - Street 1:111 S 13TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4105
Practice Address - Country:US
Practice Address - Phone:360-336-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000120367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA430018589OtherRAILROAD MEDICARE
WA0068328OtherDEPARTMENT OF LAOBR AND INDUSTRIES
WA9604257Medicaid
WATH4255OtherREGENCE BLUE SHIELD
WA06755OtherREGENCE BLUE SHIELD
WA06755OtherREGENCE BLUE SHIELD