Healthcare Provider Details

I. General information

NPI: 1952033979
Provider Name (Legal Business Name): LACI L THORNTON MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BROADWAY ST
VINCENNES IN
47591-1251
US

IV. Provider business mailing address

15549 LAKE LAWRENCE RD
LAWRENCEVILLE IL
62439-4722
US

V. Phone/Fax

Practice location:
  • Phone: 812-790-2599
  • Fax:
Mailing address:
  • Phone: 618-928-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71013870A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number041348592
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209026582
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number28177544A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: