Kelli Sue Thompson, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP11562 Issued in AZ

Practice address

18555 N 79TH Ave Ste D101
Glendale, AZ 85308-6040

Phone

(480) 563-8009

Fax

(480) 563-8009

NPI assigned

Mar 1, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kelli Beasley Former name

Medicare fee-for-service enrollment

Enrolled in TX, GA, NY3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sliiip Medical Group P aGroup PAC ID 8426469826, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sliiip Medical Group P a

  • Sleep Medicine (Internal Medicine) Physician
  • Byron, GA
  • NPI 1942768536

  NY, TX

  Medicare reassignment Care Compare group NPD
• Emh Central NW Austin Clinic PLLC

  • Professional Counselor
  • Austin, TX
  • NPI 1932834371
  Medicare reassignment NPD
• Mark Malone MD PA

  • Pain Medicine (Anesthesiology) Physician
  • Round Rock, TX
  • NPI 1407057250
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1124488317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9977 N 90TH ST STE 350",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584434",
            "telephone_number": "480-245-6126",
            "fax_number": "480-563-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18555 N 79TH AVE STE D101",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086040",
            "telephone_number": "480-563-8009",
            "fax_number": "480-563-8009"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 S W S Young Dr",
            "address_2": "SUITE 201",
            "address_purpose": "LOCATION",
            "city": "Killeen",
            "state": "TX",
            "postal_code": "765423311",
            "country_code": "US",
            "telephone_number": "254-245-9175",
            "fax_number": "254-213-7771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "KELLI",
        "middle_name": "SUE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-01",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP128449",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP11562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "356798401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "BEASLEY",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shelly Thome, LPC, CCTP, CCTSI
• Colin Michael Thompson, MD
• Dana Leslie Thompson, MS RD CNSC CDE
• George Nirvano Thompson Sr., DPM
• Jana Beth Thompson, CCC-SLP
• Linda Lee Thompson
• Mikaela L Thompson, MOT, OTR/L
• Sharon Yvonne Thompson
• Brea Hope Thomson, RBT
• Mickie Ann Thomson, PTA

• Nurse Practitioner in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.