Provider Demographics
NPI:1134714009
Name:THOMPSON, KEARA SUSANNA (NP)
Entity type:Individual
Prefix:
First Name:KEARA
Middle Name:SUSANNA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KEARA
Other - Middle Name:SUSANNA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:926 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4369
Mailing Address - Country:US
Mailing Address - Phone:989-753-8453
Mailing Address - Fax:989-755-9983
Practice Address - Street 1:926 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4369
Practice Address - Country:US
Practice Address - Phone:989-753-8453
Practice Address - Fax:989-755-9983
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704348717363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology