Provider Demographics
NPI:1497582977
Name:THOMPSON, ASHLEY RANDAL
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RANDAL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4169 SMITH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8562
Mailing Address - Country:US
Mailing Address - Phone:304-410-3983
Mailing Address - Fax:
Practice Address - Street 1:4169 SMITH CREEK RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8562
Practice Address - Country:US
Practice Address - Phone:304-410-3983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant