Provider Demographics
NPI:1710348453
Name:THORNBURG, KORY (CNP, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KORY
Middle Name:
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 QUADRAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8375
Mailing Address - Country:US
Mailing Address - Phone:330-336-3280
Mailing Address - Fax:330-336-5325
Practice Address - Street 1:4445 KENT RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4332
Practice Address - Country:US
Practice Address - Phone:330-678-0040
Practice Address - Fax:330-673-4554
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.347169-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner