Provider Demographics
NPI:1841628385
Name:THIBERVILLE, SUNNIE JO (RN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:SUNNIE
Middle Name:JO
Last Name:THIBERVILLE
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4372
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:1924 PINE ST STE 401A
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2452
Practice Address - Country:US
Practice Address - Phone:325-670-4000
Practice Address - Fax:325-670-4008
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX709790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily