Healthcare Provider Details

I. General information

NPI: 1619123676
Provider Name (Legal Business Name): WILLIAM J THORNTON APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 HIGHWAY 411
VONORE TN
37885-2455
US

IV. Provider business mailing address

1206 HIGHWAY 411
VONORE TN
37885-2455
US

V. Phone/Fax

Practice location:
  • Phone: 423-884-7271
  • Fax:
Mailing address:
  • Phone: 423-253-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000129628
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000013751
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: