MEDICARE: MS. KATHLEEN J. THOMPSON PA-C

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	363A00000X	Physician Assistant	PA00742	OR

General Provider Information

NPI Number	:	1629004619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN J. THOMPSON PA-C

Provider Business Mailing Address
First Line	:	PO BOX 579
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-0579
Country	:	US
Telephone Number	:	541-766-6835
Fax Number	:	541-766-6164

Provider Business Practice Location Address
First Line	:	1023 MAIN ST
Second Line	:
City	:	SWEET HOME
State	:	OR
Zip	:	97386-1515
Country	:	US
Telephone Number	:	833-990-6300
Fax Number	:	541-766-6833

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	12/18/2024

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