Basic Information
| Provider Information | |||||||||
| NPI: | 1487689667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | KENNETH | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2329 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982737329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603366517 | ||||||||
| FaxNumber: | 3604662682 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603362178 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP30000120 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 430018589 | 01 | WA | RAILROAD MEDICARE | OTHER | 0068328 | 01 | WA | DEPARTMENT OF LAOBR AND INDUSTRIES | OTHER | 9604257 | 05 | WA | MEDICAID | TH4255 | 01 | WA | REGENCE BLUE SHIELD | OTHER | 06755 | 01 | WA | REGENCE BLUE SHIELD | OTHER |