Healthcare Provider Details

I. General information

NPI: 1619831211
Provider Name (Legal Business Name): BREAHNA PRECIOUS THORNSBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ORCHARD DR
NICHOLASVILLE KY
40356-2690
US

IV. Provider business mailing address

127 ORCHARD DR
NICHOLASVILLE KY
40356-2690
US

V. Phone/Fax

Practice location:
  • Phone: 859-887-4900
  • Fax:
Mailing address:
  • Phone: 859-887-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number289404
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: