Provider Demographics
NPI:1275006017
Name:THOMSON, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:THOMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:NH
Mailing Address - Zip Code:03836-0241
Mailing Address - Country:US
Mailing Address - Phone:917-204-1313
Mailing Address - Fax:
Practice Address - Street 1:32 N HIGH ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1125
Practice Address - Country:US
Practice Address - Phone:207-647-5629
Practice Address - Fax:207-647-5620
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH068068-23363LP0808X
MECNP181313363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health