Healthcare Provider Details
I. General information
NPI: 1134822166
Provider Name (Legal Business Name): AUDREY KATHLEEN THOMPSON RN, IBCLC, CCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1035 BROWNSTONE DR
MARIETTA GA
30008-3233
US
IV. Provider business mailing address
1035 BROWNSTONE DR
MARIETTA GA
30008-3233
US
V. Phone/Fax
- Phone: 404-956-4715
- Fax:
- Phone: 404-956-4715
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN0003X |
| Taxonomy | Low-Risk Neonatal Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WL0100X |
| Taxonomy | Lactation Consultant (Registered Nurse) |
| License Number | RN169699 |
| License Number State | GA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0102X |
| Taxonomy | Maternal Newborn Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN0002X |
| Taxonomy | Neonatal Intensive Care Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX0003X |
| Taxonomy | Inpatient Obstetric Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN1003X |
| Taxonomy | Nutrition Support Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0200X |
| Taxonomy | Pediatric Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0808X |
| Taxonomy | Psychiatric/Mental Health Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX0002X |
| Taxonomy | High-Risk Obstetric Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WP1700X |
| Taxonomy | Perinatal Registered Nurse |
| License Number | RN169699 |
| License Number State | GA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
