Healthcare Provider Details

I. General information

NPI: 1649153602
Provider Name (Legal Business Name): KATELYN COLBURN THOMPSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W ADAMS AVE STE 100
TEMPLE TX
76501-4211
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-742-3700
  • Fax: 254-724-3701
Mailing address:
  • Phone: 800-994-0371
  • Fax: 254-215-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1207786
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: