Provider Demographics
NPI:1558529255
Name:THOMPSON, KATHRYN NIXON (PA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NIXON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RIVERGATE DR
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3613
Mailing Address - Country:US
Mailing Address - Phone:215-280-6260
Mailing Address - Fax:
Practice Address - Street 1:4 CORPORATE DR.
Practice Address - Street 2:SUITE 386
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-538-5682
Practice Address - Fax:203-538-5685
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051343363AM0700X
CT002741363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical