Provider Demographics
NPI:1346934130
Name:THOMPSON, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ANDYS DR
Mailing Address - Street 2:
Mailing Address - City:HARTS
Mailing Address - State:WV
Mailing Address - Zip Code:25524-9734
Mailing Address - Country:US
Mailing Address - Phone:304-688-3365
Mailing Address - Fax:
Practice Address - Street 1:38 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3452
Practice Address - Country:US
Practice Address - Phone:304-792-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV116483363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner