Provider Demographics
NPI:1659516581
Name:THOMPSON, KASSY (CPNP)
Entity Type:Individual
Prefix:MS
First Name:KASSY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:STE 4
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-514-6300
Mailing Address - Fax:978-514-6324
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:STE 4
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-514-6300
Practice Address - Fax:978-514-6324
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN273957208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN273957OtherSTATE LICENSE NUMBER
MAMT07422041OtherSTATE CONTROLLED SUBSTANCE