Healthcare Provider Details

I. General information

NPI: 1306288485
Provider Name (Legal Business Name): AMY THOMPSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E 7TH ST UNIT A
CHARLOTTE NC
28204-4398
US

IV. Provider business mailing address

PO BOX 63376
CHARLOTTE NC
28263-3851
US

V. Phone/Fax

Practice location:
  • Phone: 704-998-0840
  • Fax: 43-762-2167
Mailing address:
  • Phone: 704-372-7900
  • Fax: 704-376-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMPA4986PA
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103675
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: