Individual
MS. HOLLY GWEN THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
26 ELM STREET, WINFIELD, WV 25213
(304) 586-6362
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-002246
VA
363A00000X
Physician Assistant
1062
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001718835
WV BCBS
WV
01
—
1071915
WV DWC
WV
Enumeration date
10/20/2006
Last updated
11/13/2008
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