Provider Demographics
NPI:1033131404
Name:THORNTON, CELESTE (PA)
Entity Type:Individual
Prefix:MISS
First Name:CELESTE
Middle Name:
Last Name:THORNTON
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 1:4775 HAMILTON WOLFE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3456
Mailing Address - Country:US
Mailing Address - Phone:210-616-0283
Mailing Address - Fax:210-616-0071
Practice Address - Street 1:4775 HAMILTON WOLFE RD STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3456
Practice Address - Country:US
Practice Address - Phone:210-616-0283
Practice Address - Fax:210-616-0071
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02892363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211256701Medicaid
TX211256701Medicaid