MEDICARE: KAUWONNA THOMPSON

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	103K00000X	Behavior Analyst
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1235544412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAUWONNA THOMPSON

Provider Business Mailing Address
First Line	:	3530 E FLAMINGO RD
Second Line	:	STE. 140
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5069
Country	:	US
Telephone Number	:	702-570-5421
Fax Number	:	702-570-5062

Provider Business Practice Location Address
First Line	:	2551 S FORT APACHE RD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8700
Country	:	US
Telephone Number	:	702-385-0920
Fax Number	:

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	12/03/2024

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Directions to “ KAUWONNA THOMPSON ” Practice Location

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