Provider Demographics
NPI:1417944331
Name:THORNHILL, BRENDA K (CFNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:THORNHILL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SUMRALL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-2652
Mailing Address - Country:US
Mailing Address - Phone:601-736-6443
Mailing Address - Fax:601-736-2543
Practice Address - Street 1:912 SUMRALL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2652
Practice Address - Country:US
Practice Address - Phone:601-736-6443
Practice Address - Fax:601-736-2543
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR126010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121103Medicaid
MS500000513Medicare ID - Type UnspecifiedMC PART B NUMBER
MS00121103Medicaid