Individual
MR. EVAN SCOTT THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC, AEMT
Contact information
Practice address
580 COURT ST, KEENE, NH 03431-1729
(603) 354-5400
Mailing address
1260 ELM ST, MANCHESTER, NH 03101-1305
(603) 314-1701
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
30091
NH
2255A2300X
Athletic Trainer
0555
NH
363A00000X
Physician Assistant
Primary
2009
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0555
NH STATE ATHLETIC TRAINING LICENSE
NH
01
—
2000012822
BOARD OF CERTIFICATION
—
01
—
30091A
NH DEPT. OF SAFETY; DIVISION OF FIRE STANDARDS & TRAINING AND EMS; BUREAU OF EMS
NH
01
—
A2022946
NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS
NH
Enumeration date
12/16/2014
Last updated
05/04/2023
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