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General NPI Number Information
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NPI Number | 1942017579
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Entity Type | Individual
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Provider Name | BETHANY JEAN THOMPSON PA
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Gender | Female
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2550 UNIVERSITY AVE W STE 130N
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City | SAINT PAUL
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State | MN
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Zip | 55114-1096
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Country | US
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Telephone | 651-447-3755
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Fax |
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Provider Business Mailing Address
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Address Line | S1765 SIMPSON RD
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City | REEDSBURG
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State | WI
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Zip | 53959-9764
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Country | US
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Telephone | 608-963-8258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15153
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License Number State | MN
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