Provider Demographics
NPI:1871005884
Name:THOMPSON, KATIE MICHELLE (NP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MICHELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DAVID THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-4948
Mailing Address - Country:US
Mailing Address - Phone:208-267-3934
Mailing Address - Fax:
Practice Address - Street 1:32 DAVID THOMPSON DR
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-4948
Practice Address - Country:US
Practice Address - Phone:208-267-3934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003270363LP0200X
ID3771170363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics