Provider Demographics
NPI:1235489865
Name:THOMPSON, KRISTA KAY (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:KAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:KAY
Other - Last Name:QUICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:204 SAVANNAH ST
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9608
Mailing Address - Country:US
Mailing Address - Phone:608-574-4618
Mailing Address - Fax:
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-416-1527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3025-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant