MEDICARE: ASHLEY THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1417789900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY THOMPSON

Provider Business Mailing Address
First Line	:	8170 33RD AVE S # MS 21110Q
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 INGLEWOOD AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4112
Country	:	US
Telephone Number	:	914-589-5503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	12/09/2025

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