Provider Demographics
NPI:1245821735
Name:THOMPSON, KASEY KRISTEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:KRISTEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 CRAWFORD DR SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-0218
Mailing Address - Country:US
Mailing Address - Phone:423-453-9000
Mailing Address - Fax:
Practice Address - Street 1:188 16TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1037
Practice Address - Country:US
Practice Address - Phone:423-775-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant