Provider Demographics
NPI:1558468702
Name:THOMPSON, KAREN JO (CRNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JO
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MAIN ST
Mailing Address - Street 2:P O BOX 307
Mailing Address - City:WEDOWEE
Mailing Address - State:AL
Mailing Address - Zip Code:36278
Mailing Address - Country:US
Mailing Address - Phone:256-357-2111
Mailing Address - Fax:256-357-0175
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEDOWEE
Practice Address - State:AL
Practice Address - Zip Code:36278
Practice Address - Country:US
Practice Address - Phone:256-357-2111
Practice Address - Fax:256-357-0175
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP51537Medicare UPIN