Provider Demographics
NPI:1851715668
Name:THORNTON, AUTUMN (CST-CSFA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:CST-CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 E 81ST ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4200
Mailing Address - Country:US
Mailing Address - Phone:918-477-5033
Mailing Address - Fax:918-477-5992
Practice Address - Street 1:2408 E 81ST ST
Practice Address - Street 2:SUITE 900
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4200
Practice Address - Country:US
Practice Address - Phone:918-477-5033
Practice Address - Fax:918-477-5992
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK125883OtherCERTIFICATION NUMBER