Provider Demographics
NPI:1396936209
Name:THOMPSON, CHRISTINA PENELOPE (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:PENELOPE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:PENELOPE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:535 W 2ND ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-9002
Mailing Address - Country:US
Mailing Address - Phone:859-388-9152
Mailing Address - Fax:859-255-5385
Practice Address - Street 1:535 W 2ND ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-9002
Practice Address - Country:US
Practice Address - Phone:859-388-9152
Practice Address - Fax:859-255-5385
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0736102Medicare PIN