Provider Demographics
NPI:1033226998
Name:THOMPSON, JASEN RUSSELL (PA-C)
Entity Type:Individual
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First Name:JASEN
Middle Name:RUSSELL
Last Name:THOMPSON
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1001 S KNIK GOOSE BAY RD
Mailing Address - Street 2:PCC WEST
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8083
Mailing Address - Country:US
Mailing Address - Phone:907-631-7851
Mailing Address - Fax:907-631-7612
Practice Address - Street 1:1001 S KNIK GOOSE BAY RD
Practice Address - Street 2:PCC WEST
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8083
Practice Address - Country:US
Practice Address - Phone:907-631-7851
Practice Address - Fax:907-631-7612
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-07-16
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Provider Licenses
StateLicense IDTaxonomies
AK620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant