1659728772 NPI number — JENNIFER R. THORNTON NP-C

Table of content: JENNIFER R. THORNTON NP-C (NPI 1659728772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659728772 NPI number — JENNIFER R. THORNTON NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNTON
Provider First Name:
JENNIFER
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659728772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415000
Provider Second Line Business Mailing Address:
LBX 410604
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37241-0604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-798-4664
Provider Business Mailing Address Fax Number:
318-798-4457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHITOCHES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71457-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-238-3322
Provider Business Practice Location Address Fax Number:
318-238-3323
Provider Enumeration Date:
05/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP08825 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2422456 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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