MEDICARE: KRISTY L THOMPSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN20749	SC

General Provider Information

NPI Number	:	1124568514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY L THOMPSON NP

Provider Business Mailing Address
First Line	:	7001 SAINT ANDREWS RD STE 307
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	806-390-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 SAINT ANDREWS RD STE 307
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	806-390-9940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	10/24/2022

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