MEDICARE: SUNNIE JO THIBERVILLE RN, MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	709790	TX

General Provider Information

NPI Number	:	1841628385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNIE JO THIBERVILLE RN, MSN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1198
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79604-1198
Country	:	US
Telephone Number	:	325-670-4372
Fax Number	:	325-670-4040

Provider Business Practice Location Address
First Line	:	1924 PINE ST STE 401A
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-2452
Country	:	US
Telephone Number	:	325-670-4000
Fax Number	:	325-670-4008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2013
Last Update Date	:	02/26/2015

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