Healthcare Provider Details

I. General information

NPI: 1659772028
Provider Name (Legal Business Name): KIM ESTELLA THOMPSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 GLACIER HWY
JUNEAU AK
99801-7251
US

IV. Provider business mailing address

3406 GLACIER HWY
JUNEAU AK
99801-7251
US

V. Phone/Fax

Practice location:
  • Phone: 907-463-3303
  • Fax: 907-463-6858
Mailing address:
  • Phone: 907-463-3303
  • Fax: 907-463-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number197275-8900
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number252138
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number197275-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: