Provider Demographics
NPI:1922003391
Name:THURMOND, JANICE (APRN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:THURMOND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2404
Mailing Address - Country:US
Mailing Address - Phone:270-753-4616
Mailing Address - Fax:270-767-3623
Practice Address - Street 1:305 S 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2404
Practice Address - Country:US
Practice Address - Phone:270-753-4616
Practice Address - Fax:270-767-3623
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78245107Medicaid
KY78245107Medicaid
KY0791407Medicare PIN