MEDICARE: KATHY J THOMPKINS APRN

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	363LF0000X	Family Nurse Practitioner	3342	SC

General Provider Information

NPI Number	:	1295921591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY J THOMPKINS APRN

Provider Business Mailing Address
First Line	:	1002 S MAIN ST
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-3920
Country	:	US
Telephone Number	:	843-464-8205
Fax Number	:	843-464-8206

Provider Business Practice Location Address
First Line	:	1002 S MAIN ST
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-3920
Country	:	US
Telephone Number	:	843-464-8205
Fax Number	:	843-464-8206

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	04/04/2011

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