Provider Demographics
NPI:1558673962
Name:THORNTON, PATRICIA SMOCK (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SMOCK
Last Name:THORNTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:SMOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4863 N NEVADA AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3951
Mailing Address - Country:US
Mailing Address - Phone:719-255-8001
Mailing Address - Fax:719-255-8044
Practice Address - Street 1:4863 N NEVADA AVE STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3951
Practice Address - Country:US
Practice Address - Phone:719-255-8001
Practice Address - Fax:719-255-8044
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990231363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97150762Medicaid