Provider Demographics
NPI:1942584529
Name:THOMPSON, KRISTINA DIANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:DIANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1348 OHIO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3937
Mailing Address - Country:US
Mailing Address - Phone:812-232-6628
Mailing Address - Fax:812-645-0324
Practice Address - Street 1:1348 OHIO ST
Practice Address - Street 2:SUITE B
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3937
Practice Address - Country:US
Practice Address - Phone:812-232-6628
Practice Address - Fax:812-645-0324
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2013-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02004077A207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice