Corey Thompson, PA-C
Individual provider Active NPI Physician Assistant · Waltham, MN
NPI 1386228583 · NPPES record last updated May 12, 2021
Key facts
- NPI
- 1386228583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 13635 (MN)
- Practice address
- 33528 600TH Ave
Waltham, MN 55982-7681 - Phone
- (507) 279-2510
- NPI assigned
- May 12, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13635 | MN | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 13635 | MN | Yes |
Addresses
Primary practice location
33528 600TH Ave
Waltham, MN 55982-7681
Mailing address
33528 600TH Ave
Waltham, MN 55982-7681
Phone (507) 279-2510
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.