Healthcare Provider Details

I. General information

NPI: 1417944331
Provider Name (Legal Business Name): BRENDA K THORNHILL CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SUMRALL RD
COLUMBIA MS
39429-2652
US

IV. Provider business mailing address

912 SUMRALL RD
COLUMBIA MS
39429-2652
US

V. Phone/Fax

Practice location:
  • Phone: 601-736-6443
  • Fax: 601-736-2543
Mailing address:
  • Phone: 601-736-6443
  • Fax: 601-736-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR126010
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: