Healthcare Provider Details

I. General information

NPI: 1952959298
Provider Name (Legal Business Name): KLARYSA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 E RAY RD # 9
PHOENIX AZ
85044-6405
US

IV. Provider business mailing address

4802 E RAY RD # 9
PHOENIX AZ
85044-6405
US

V. Phone/Fax

Practice location:
  • Phone: 480-550-7854
  • Fax:
Mailing address:
  • Phone: 480-550-7854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9037718-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: