Provider Demographics
NPI:1346559911
Name:THOMPSON, BRIDGET NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:NICOLE
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:PO BOX 17990
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4074
Mailing Address - Country:US
Mailing Address - Phone:910-652-2663
Mailing Address - Fax:910-652-3150
Practice Address - Street 1:112 E BALLARD ST
Practice Address - Street 2:
Practice Address - City:ELLERBE
Practice Address - State:NC
Practice Address - Zip Code:28338-9730
Practice Address - Country:US
Practice Address - Phone:910-652-2663
Practice Address - Fax:910-652-3150
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1346559911Medicaid
NC1346559911Medicaid