Provider Demographics
NPI:1871836254
Name:THOMPSON, KRISTA KELLY (APRN)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:KELLY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LINCOLN PARK RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1355
Mailing Address - Country:US
Mailing Address - Phone:502-205-0361
Mailing Address - Fax:
Practice Address - Street 1:300 LINCOLN PARK RD UNIT 4
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1355
Practice Address - Country:US
Practice Address - Phone:502-205-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011395363LP0808X
AZRN151597163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse