Provider Demographics
NPI:1255975389
Name:THORNTON, RIAN KENNETH
Entity type:Individual
Prefix:
First Name:RIAN
Middle Name:KENNETH
Last Name:THORNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:179 N BUNCOMBE SCHOOL RD STE 102
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9699
Practice Address - Country:US
Practice Address - Phone:828-645-3100
Practice Address - Fax:828-658-3254
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012630363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCEINMedicaid