Provider Demographics
NPI:1326340530
Name:THORNBURY, AMY (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:THORNBURY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N RACE ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3454
Mailing Address - Country:US
Mailing Address - Phone:270-651-3729
Mailing Address - Fax:270-651-1899
Practice Address - Street 1:1301 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3454
Practice Address - Country:US
Practice Address - Phone:270-651-3729
Practice Address - Fax:270-651-1899
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100185810Medicaid