Provider Demographics
NPI:1083957880
Name:THORNTON, KIMBERLY MICHELLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:MICHELLE
Other - Last Name:CARLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:820 GALE LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3012
Mailing Address - Country:US
Mailing Address - Phone:615-298-5406
Mailing Address - Fax:615-577-4010
Practice Address - Street 1:820 GALE LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3012
Practice Address - Country:US
Practice Address - Phone:615-298-5406
Practice Address - Fax:615-577-4010
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-505363A00000X
TNPA0000002751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198732795Medicaid
AR198732795Medicaid