Healthcare Provider Details

I. General information

NPI: 1942514385
Provider Name (Legal Business Name): KASEY THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ELLINGTON DR
RAYVILLE LA
71269-3632
US

IV. Provider business mailing address

254 HIGHWAY 3048
RAYVILLE LA
71269-3624
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-4181
  • Fax:
Mailing address:
  • Phone: 318-728-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN106553
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP002425
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: