Provider Demographics
NPI:1063787059
Name:THOMPSON, TIFFANY AMANDA (DO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMANDA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 KY ROUTE 321 STE 3124
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9113
Mailing Address - Country:US
Mailing Address - Phone:606-889-3659
Mailing Address - Fax:606-886-7615
Practice Address - Street 1:5000 KY ROUTE 321 STE 3124
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-889-3659
Practice Address - Fax:606-886-7615
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100409610Medicaid