Provider Demographics
NPI:1306288485
Name:THOMPSON, AMY (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63376
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3851
Mailing Address - Country:US
Mailing Address - Phone:704-372-7900
Mailing Address - Fax:704-376-2216
Practice Address - Street 1:2600 E 7TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4398
Practice Address - Country:US
Practice Address - Phone:704-998-0840
Practice Address - Fax:043-762-2167
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA4986PA363A00000X
NC103675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant