Healthcare Provider Details

I. General information

NPI: 1043450745
Provider Name (Legal Business Name): KATHLEEN RAE THOMPSON R,N,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN RAE WESTON R.N.

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 10/15/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER ROAD
KYLE SD
57752-0540
US

IV. Provider business mailing address

1000 HEALTH CENTER ROAD
KYLE SD
57752-0540
US

V. Phone/Fax

Practice location:
  • Phone: 605-455-2451
  • Fax: 605-455-2808
Mailing address:
  • Phone: 605-455-2451
  • Fax: 605-455-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR037279
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR037279
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: