Provider Demographics
NPI:1740937291
Name:THOMPSON, BETHANY ANNE (APRN, CNM)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:ANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:ANNE
Other - Last Name:MCKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 JACOB LN
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1776
Practice Address - Country:US
Practice Address - Phone:763-587-4200
Practice Address - Fax:763-587-4205
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN500367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife