Healthcare Provider Details

I. General information

NPI: 1659028744
Provider Name (Legal Business Name): KERA THOMPSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 FREDERICK AVE
SAINT JOSEPH MO
64506-3016
US

IV. Provider business mailing address

3620 FREDERICK AVE
SAINT JOSEPH MO
64506-3016
US

V. Phone/Fax

Practice location:
  • Phone: 660-562-7999
  • Fax: 660-562-7996
Mailing address:
  • Phone: 660-562-7999
  • Fax: 660-562-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number2022002789
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: