Healthcare Provider Details

I. General information

NPI: 1366305518
Provider Name (Legal Business Name): CHRISTINA FRANCESSCA THORNTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 EVELYN GANDY PKWY
PETAL MS
39465-3947
US

IV. Provider business mailing address

1146 EVELYN GANDY PKWY
PETAL MS
39465-3947
US

V. Phone/Fax

Practice location:
  • Phone: 601-584-4309
  • Fax:
Mailing address:
  • Phone: 601-268-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908014
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: