Provider Demographics
NPI:1245886670
Name:THORNTON, CAITLIN A (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:A
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4205
Mailing Address - Country:US
Mailing Address - Phone:719-248-4356
Mailing Address - Fax:
Practice Address - Street 1:2500 CANTERBURY DR STE 112
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2258
Practice Address - Country:US
Practice Address - Phone:785-261-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12884363A00000X
KS1502235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant