Provider Demographics
NPI:1235306234
Name:THOMPSON, AMBER (PA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 FAIRVIEW RD STE 320
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3324
Mailing Address - Country:US
Mailing Address - Phone:704-200-9805
Mailing Address - Fax:
Practice Address - Street 1:6700 FAIRVIEW RD STE 320
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3324
Practice Address - Country:US
Practice Address - Phone:704-200-9805
Practice Address - Fax:833-909-3961
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1256858OtherWELLCARE
FL9674631OtherAETNA
FLP1036150OtherFREEDOM
FL9213412OtherCIGNA
FLP971793OtherOPTIMUM
FL398640OtherAVMED
FLP01619552OtherRR MEDICARE
FL016550700Medicaid
FLP01807769OtherCLEAR HEALTH ALLIANCE
FLY06R3OtherBCBS
FL016550700Medicaid