Provider Demographics
NPI:1891219010
Name:THORNTON, JAMIE B (BS)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:B
Last Name:THORNTON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:B
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:604 TWIN DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6737
Mailing Address - Country:US
Mailing Address - Phone:575-626-7198
Mailing Address - Fax:
Practice Address - Street 1:604 TWIN DIAMOND RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6737
Practice Address - Country:US
Practice Address - Phone:575-626-7198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician