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NPI Code Detail

MEDICARE: KELLY LEE THOMPSON CRNA

MEDICARE:   KELLY LEE THOMPSON  CRNA
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
1367500000XCertified Registered Nurse Anesthetist3132CA
2367500000XCertified Registered Nurse Anesthetist707870TX

General Provider Information

NPI Number : 1144298704
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY LEE THOMPSON CRNA
Provider Business Mailing Address
First Line : 5731 CHAMPION CT
Second Line :
City : ARLINGTON
State : TX
Zip : 76017-4213
Country : US
Telephone Number : 619-961-6753
Fax Number :
Provider Business Practice Location Address
First Line : 5731 CHAMPION CT
Second Line :
City : ARLINGTON
State : TX
Zip : 76017-4213
Country : US
Telephone Number : 619-961-6753
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 11/29/2021

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Directions to “ KELLY LEE THOMPSON CRNA” Practice Location

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