Provider Demographics
NPI:1649601170
Name:THORSON, KELLY A (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:THORSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:WIEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2 E MAIN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:NH
Mailing Address - Zip Code:03278-4421
Mailing Address - Country:US
Mailing Address - Phone:603-456-6106
Mailing Address - Fax:603-227-7566
Practice Address - Street 1:2 E MAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:NH
Practice Address - Zip Code:03278-4421
Practice Address - Country:US
Practice Address - Phone:603-456-6106
Practice Address - Fax:603-227-7566
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046751-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily