Provider Demographics
NPI:1891940698
Name:THOMPSON, FEROZA (PA)
Entity type:Individual
Prefix:
First Name:FEROZA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 W SKYE CANYON PARK DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-6627
Mailing Address - Country:US
Mailing Address - Phone:702-488-0842
Mailing Address - Fax:
Practice Address - Street 1:340 FALCON RIDGE PKWY STE 400-404
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8850
Practice Address - Country:US
Practice Address - Phone:702-346-5510
Practice Address - Fax:702-346-2557
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2306363A00000X
FLPA 9104996363AM0700X
NVPA0578363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA2306OtherSTATE LICENSE
NV1891940698Medicaid