Healthcare Provider Details

I. General information

NPI: 1356010037
Provider Name (Legal Business Name): MRS. AURELIA FAYE THORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 KENYON RD
TWIN FALLS ID
83301-5648
US

IV. Provider business mailing address

520 13TH AVE N
BUHL ID
83316-1515
US

V. Phone/Fax

Practice location:
  • Phone: 208-308-0158
  • Fax:
Mailing address:
  • Phone: 208-308-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: