Healthcare Provider Details

I. General information

NPI: 1245414051
Provider Name (Legal Business Name): MS. KRISTEN MARIE THOMPSON-BLANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150A COURT AVE
HAMLIN WV
25523-1434
US

IV. Provider business mailing address

6230 WALMOTT DR
HUNTINGTON WV
25705-2438
US

V. Phone/Fax

Practice location:
  • Phone: 304-824-7776
  • Fax: 304-824-7776
Mailing address:
  • Phone: 304-544-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number958
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: