Provider Demographics
NPI:1659915924
Name:THOMPSON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:PENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 MEDDIN LN
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-9852
Mailing Address - Country:US
Mailing Address - Phone:915-345-0039
Mailing Address - Fax:
Practice Address - Street 1:4750 WATERS AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6278
Practice Address - Country:US
Practice Address - Phone:912-350-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN254865363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily