Provider Demographics
NPI:1477280014
Name:THURSTON, KELLEY MARIE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:MARIE
Last Name:THURSTON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-8425
Mailing Address - Country:US
Mailing Address - Phone:903-399-9792
Mailing Address - Fax:
Practice Address - Street 1:1207A E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5604
Practice Address - Country:US
Practice Address - Phone:903-907-7003
Practice Address - Fax:430-558-5861
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily