Healthcare Provider Details

I. General information

NPI: 1063325603
Provider Name (Legal Business Name): PATRICK RYAN THOMPSON PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 6TH ST
DUNBAR WV
25064-3204
US

IV. Provider business mailing address

213 LOCUST AVE
FAIRMONT WV
26554-1631
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-0060
  • Fax:
Mailing address:
  • Phone: 304-494-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number26-9108
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: