Provider Demographics
NPI:1447238357
Name:THORNSBERRY, SHEILA ELAINE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:ELAINE
Last Name:THORNSBERRY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 DOVE RUN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502
Mailing Address - Country:US
Mailing Address - Phone:859-269-4668
Mailing Address - Fax:859-266-5577
Practice Address - Street 1:1055 DOVE RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502
Practice Address - Country:US
Practice Address - Phone:859-269-4668
Practice Address - Fax:859-266-5577
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA254363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95000154Medicaid
KY0905215Medicare ID - Type Unspecified
KY0693023Medicare ID - Type Unspecified
KY95000154Medicaid
R84760Medicare UPIN