| Doctor Name: | JOANNA RAE THOMPSON |
| NPI Number: | 1346411568 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1631 |
| Business Practice Address: | 289 Ireland Ave Fort Knox, KY - 401215111 |
| Business Phone Number: | 5026249007 |
| Business Fax Number: | |
| Mailing Address: | 137 E Eastern Hills Blvd, SALEM |
| State: | IN |
| Postal Code: | 471679719 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/15/2008 |
| NPI Last Update Date: | 03/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 1631 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |