Individual
DR. KENNETH ALLAN THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7601 SOUTHCREST PKWY, SOUTHAVEN, MS 38671-4739
(662) 772-3260
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-4706
(662) 772-3260
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
00025767
AL
207P00000X
Emergency Medicine Physician
Primary
19372
MS
207P00000X
Emergency Medicine Physician
41139
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07781813
—
MS
05
—
3829824
—
TN
01
—
4133803
BLUE CROSS
TN
01
—
P00388668
RAILROAD MEDICARE
TN
Enumeration date
10/11/2005
Last updated
01/25/2008
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