Individual
KIMBERLY AILENE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1321 CLARA AVE, FORT WAYNE, IN 46805-3517
(231) 215-6960
Mailing address
1321 CLARA AVE, FORT WAYNE, IN 46805-3517
(231) 215-6960
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
6292-2352
IN
164W00000X
Licensed Practical Nurse
Primary
27073046A
IN
164W00000X
Licensed Practical Nurse
4703096215
MI
Other
Enumeration date
05/06/2016
Last updated
05/06/2016
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