Provider Demographics
NPI:1255458402
Name:THOMSPON, KATHY JEAN (NURSE)
Entity type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:JEAN
Last Name:THOMSPON
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:JEAN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:CLEAR SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:21722-0391
Mailing Address - Country:US
Mailing Address - Phone:301-842-3801
Mailing Address - Fax:
Practice Address - Street 1:105 CUMBERLAND STREET
Practice Address - Street 2:APT 1
Practice Address - City:CLEAR SPRING
Practice Address - State:MD
Practice Address - Zip Code:21722-0391
Practice Address - Country:US
Practice Address - Phone:301-842-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP35774164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse