Provider Demographics
NPI:1770208746
Name:THOMPSON, KATHLEEN MICHELE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MICHELE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18330 PURPLE MARTIN PKWY
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4085
Mailing Address - Country:US
Mailing Address - Phone:402-289-5787
Mailing Address - Fax:
Practice Address - Street 1:18330 PURPLE MARTIN PKWY
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4085
Practice Address - Country:US
Practice Address - Phone:402-289-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant