Provider Demographics
NPI:1215597588
Name:THORNTON, JESSICA R (DNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:THORNTON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IA
Mailing Address - Zip Code:50833-1043
Mailing Address - Country:US
Mailing Address - Phone:712-523-2196
Mailing Address - Fax:712-523-2198
Practice Address - Street 1:1502 MADISON ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IA
Practice Address - Zip Code:50833-1043
Practice Address - Country:US
Practice Address - Phone:712-523-2196
Practice Address - Fax:712-523-2198
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA154989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily