Provider Demographics
NPI:1831290683
Name:THORNTON, KARYN (PAC)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40974 BIG LODGE LN
Mailing Address - Street 2:
Mailing Address - City:ROLLINS
Mailing Address - State:MT
Mailing Address - Zip Code:59931-9755
Mailing Address - Country:US
Mailing Address - Phone:406-844-0706
Mailing Address - Fax:
Practice Address - Street 1:35928 JOE MCDONALD DR
Practice Address - Street 2:
Practice Address - City:PABLO
Practice Address - State:MT
Practice Address - Zip Code:59855
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1340363A00000X
MTMED-PAC-LIC-499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41930800Medicaid
P39699Medicare UPIN
WI001372200Medicare ID - Type Unspecified