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General NPI Number Information
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NPI Number | 1194115667
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Entity Type | Individual
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Provider Name | KEISHA THOMPSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 680 BLAIR MILL RD
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City | HORSHAM
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State | PA
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Zip | 19044-2223
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Country | US
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Telephone | 610-256-9742
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Fax |
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Provider Business Mailing Address
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Address Line | 329 AUTUMN LN
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9828
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Country | US
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Telephone | 203-623-2340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP014248
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP014248
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License Number State | PA
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