Provider Demographics
NPI:1659903201
Name:THORNSBERRY, FARRAH ALAYNE (PMHNP)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:ALAYNE
Last Name:THORNSBERRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 TAYLORSVILLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2100
Mailing Address - Country:US
Mailing Address - Phone:502-721-7522
Mailing Address - Fax:
Practice Address - Street 1:2815 TAYLORSVILLE RD STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2100
Practice Address - Country:US
Practice Address - Phone:502-721-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014304363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health