Provider Demographics
NPI:1336472711
Name:THORN, ANGELA NICOLE (CPNP-PN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:NICOLE
Last Name:THORN
Suffix:
Gender:F
Credentials:CPNP-PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-2681
Mailing Address - Country:US
Mailing Address - Phone:318-623-2716
Mailing Address - Fax:
Practice Address - Street 1:609 W COURT ST STE B
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2686
Practice Address - Country:US
Practice Address - Phone:318-209-4646
Practice Address - Fax:318-209-4649
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05870363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1800139Medicaid
LA18001139Medicaid