Provider Demographics
NPI:1841248325
Name:THOMPSON, NANCY KAYE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KAYE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4479
Mailing Address - Country:US
Mailing Address - Phone:830-997-2191
Mailing Address - Fax:830-997-8202
Practice Address - Street 1:205 W WINDCREST ST
Practice Address - Street 2:SUITE 310
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4479
Practice Address - Country:US
Practice Address - Phone:830-997-2191
Practice Address - Fax:830-997-8202
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3949208000000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135009203Medicaid
TX135009203Medicaid
TX81301BMedicare ID - Type Unspecified