Healthcare Provider Details

I. General information

NPI: 1285016865
Provider Name (Legal Business Name): ASHLEY MIRANDA THOMPSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR
HAZARD KY
41701-9466
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-1818
  • Fax: 606-218-4697
Mailing address:
  • Phone: 606-430-3500
  • Fax: 606-218-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number04361
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number04361
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: