Provider Demographics
NPI:1518006717
Name:THORNSBERRY, KATHERINE MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:THORNSBERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2905
Mailing Address - Country:US
Mailing Address - Phone:501-833-2124
Mailing Address - Fax:
Practice Address - Street 1:4107 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2653
Practice Address - Country:US
Practice Address - Phone:501-955-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR42269163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics