Healthcare Provider Details

I. General information

NPI: 1336685544
Provider Name (Legal Business Name): KIMBERLY THOMPSON PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 08/12/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6648 WINDVANE POINT
CLERMONT GA
30527
US

IV. Provider business mailing address

6648 WINDVANE POINT
CLERMONT GA
30527
US

V. Phone/Fax

Practice location:
  • Phone: 919-801-2237
  • Fax:
Mailing address:
  • Phone: 919-801-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN219413
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN219413
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: