Provider Demographics
NPI:1740738830
Name:THOMPSON, KELCIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELCIE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KELCIE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:145 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2250
Mailing Address - Country:US
Mailing Address - Phone:330-633-7090
Mailing Address - Fax:330-633-8462
Practice Address - Street 1:145 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2250
Practice Address - Country:US
Practice Address - Phone:330-633-7090
Practice Address - Fax:330-633-8462
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004853RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant