Provider Demographics
NPI:1942017579
Name:THOMPSON, BETHANY JEAN (PA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:S1765 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-9764
Mailing Address - Country:US
Mailing Address - Phone:608-963-8258
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 130N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1096
Practice Address - Country:US
Practice Address - Phone:651-447-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN15153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant