Provider Demographics
NPI:1093209470
Name:THORNTON, KATHRYN BRIELLE (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BRIELLE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1448 10TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-8722
Mailing Address - Fax:304-691-8591
Practice Address - Street 1:1600 MEDICAL CENTER DR STE B500
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3655
Practice Address - Country:US
Practice Address - Phone:304-691-1787
Practice Address - Fax:304-691-8711
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL527942084N0400X
WV311992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology