Provider Demographics
NPI:1609294933
Name:THOMPSON, BENJAMIN E (APA-C)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:APA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JBER SCMH
Mailing Address - Street 2:BLDG 786 D STREET
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505
Mailing Address - Country:US
Mailing Address - Phone:907-384-2530
Mailing Address - Fax:
Practice Address - Street 1:JBER SCMH
Practice Address - Street 2:BLDG 786 D ST
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99505
Practice Address - Country:US
Practice Address - Phone:907-384-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1117332OtherNCCPA