Provider Demographics
NPI:1841683323
Name:THORNTON, TAMI (FNP)
Entity type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW MOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3118
Mailing Address - Country:US
Mailing Address - Phone:816-224-0400
Mailing Address - Fax:816-224-0418
Practice Address - Street 1:1700 NW MOCK AVE
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3118
Practice Address - Country:US
Practice Address - Phone:816-224-0400
Practice Address - Fax:816-224-0418
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015007301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily