Provider Demographics
NPI:1477530343
Name:THOMPSON, AMY A
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
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 1:600 N COTNER BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-464-5969
Mailing Address - Fax:402-464-3657
Practice Address - Street 1:315 W 11TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-7331
Practice Address - Country:US
Practice Address - Phone:402-464-5969
Practice Address - Fax:402-464-3657
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES84206Medicare UPIN
NE279576Medicare ID - Type Unspecified