Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0747 | KY |
Y | 103T00000X | Psychologist | 0747 | KY |
NPI | 1003017591 |
---|---|
Provider Name | Mary K Thompson |
First Address | Louisville, KY 40204-2046 |
Second Address | Louisville, KY 40204-2046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000050054 | ANTHEM BCBS (01) |