Provider Demographics
NPI:1245466580
Name:THOMPSON, MORGAN PETTY (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:PETTY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MAIN ST APT 314
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1497
Mailing Address - Country:US
Mailing Address - Phone:914-469-6525
Mailing Address - Fax:
Practice Address - Street 1:206 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7330
Practice Address - Country:US
Practice Address - Phone:631-847-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030595363AS0400X
NY016493363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical