Provider Demographics
NPI:1790960565
Name:THOMPSON, KELLY JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8653 SWEETWATER CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8364
Mailing Address - Country:US
Mailing Address - Phone:614-218-3153
Mailing Address - Fax:740-657-1326
Practice Address - Street 1:8653 SWEETWATER CT
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8364
Practice Address - Country:US
Practice Address - Phone:614-218-3153
Practice Address - Fax:740-657-1326
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN307640163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse