Provider Demographics
NPI:1114428315
Name:THORNTON, KATHERINE DANA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DANA
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2607 JENNIFER HOPE BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4721
Mailing Address - Country:US
Mailing Address - Phone:352-356-3456
Mailing Address - Fax:
Practice Address - Street 1:3900 JUNIUS ST STE 415
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:214-820-7100
Practice Address - Fax:214-820-6863
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical