Provider Demographics
NPI:1376941740
Name:THOMPSON, EVAN SCOTT (PA-C, ATC, AEMT)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:SCOTT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PA-C, ATC, AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1305
Mailing Address - Country:US
Mailing Address - Phone:603-314-1701
Mailing Address - Fax:
Practice Address - Street 1:580 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1729
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30091207PE0004X
NH05552255A2300X
NH2009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0555OtherNH STATE ATHLETIC TRAINING LICENSE
NH30091AOtherNH DEPT. OF SAFETY; DIVISION OF FIRE STANDARDS & TRAINING AND EMS; BUREAU OF EMS
2000012822OtherBOARD OF CERTIFICATION
NHA2022946OtherNATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS