MEDICARE: KATIE ELAINE THOMPSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN215315	GA

General Provider Information

NPI Number	:	1467106047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ELAINE THOMPSON NP

Provider Business Mailing Address
First Line	:	1285 HEMBREE RD STE 100
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-5715
Country	:	US
Telephone Number	:	770-442-1050
Fax Number	:	770-475-1621

Provider Business Practice Location Address
First Line	:	1285 HEMBREE RD STE 100
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-5715
Country	:	US
Telephone Number	:	770-442-1050
Fax Number	:	770-475-1621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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Directions to “ KATIE ELAINE THOMPSON NP” Practice Location

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