Provider Demographics
NPI:1780817858
Name:THORSON, KIM A (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:THORSON
Suffix:
Gender:F
Credentials: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:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-857-5650
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:111 1ST ST W
Practice Address - Street 2:
Practice Address - City:VELVA
Practice Address - State:ND
Practice Address - Zip Code:58790-7018
Practice Address - Country:US
Practice Address - Phone:701-338-2066
Practice Address - Fax:701-338-2048
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily