Provider Demographics
NPI:1710397039
Name:THOMPSON, KRISTINA LORENE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LORENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LORENE
Other - Last Name:BERNS-THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:37868 US-18
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821
Mailing Address - Country:US
Mailing Address - Phone:608-357-2525
Mailing Address - Fax:
Practice Address - Street 1:37868 US-18
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821
Practice Address - Country:US
Practice Address - Phone:608-357-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO39020000X390200000X
WI1100-25213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program