Individual
ANDREA L THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1444 E STEARNS ST STE 11, FAYETTEVILLE, AR 72703-6243
(479) 718-7546
(479) 966-4979
Mailing address
1444 E STEARNS ST STE 11, FAYETTEVILLE, AR 72703-6243
(479) 718-7546
(479) 966-4979
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001125
CT
363A00000X
Physician Assistant
Primary
PA-412
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5F922P253
MEDICARE PA PTAN
AR
Enumeration date
06/14/2005
Last updated
08/29/2012
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