Provider Demographics
NPI:1003114067
Name:THOMPSON, LUKE KENAN (PA)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:KENAN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LIVINGSTON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801
Mailing Address - Country:US
Mailing Address - Phone:828-253-4851
Mailing Address - Fax:828-252-1969
Practice Address - Street 1:60 LIVINGSTON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-253-4851
Practice Address - Fax:828-252-1969
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02652363A00000X
SC1623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC048Medicaid
SC372048Medicaid
SC421896Medicare Oscar/Certification
SC372048Medicaid