Provider Demographics
NPI:1083716567
Name:THOMPSON, JEFFREY GLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GLEN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:SUITE 302
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-7600
Practice Address - Fax:540-639-5400
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2022-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001964363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical