Provider Demographics
NPI:1154315885
Name:THOMPSON, SARA LEANNE (PA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LEANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WALNUT ST
Mailing Address - Street 2:#101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2292
Mailing Address - Country:US
Mailing Address - Phone:785-787-9438
Mailing Address - Fax:
Practice Address - Street 1:4200 E 9TH AVE
Practice Address - Street 2:B215
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80262-0001
Practice Address - Country:US
Practice Address - Phone:303-372-8643
Practice Address - Fax:303-372-8522
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00913363A00000X
COPA2248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042039OtherBLUE CROSS BLUE SHIELD
KSP98904Medicare UPIN
KS042039Medicare ID - Type Unspecified