Healthcare Provider Details

I. General information

NPI: 1396915153
Provider Name (Legal Business Name): KRISTY TYLER THURSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2008
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 425
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

85 SEYMOUR ST SUITE 425
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 860-548-7336
  • Fax: 860-524-2651
Mailing address:
  • Phone: 860-548-7336
  • Fax: 860-524-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number051838
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number051838
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: