=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013232990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY W. THURSTON ARNP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2010
-----------------------------------------------------
Last Update Date | 09/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6212 75TH ST W
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98499-8368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-983-1539
-----------------------------------------------------
Fax | 253-588-2693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6212 75TH ST W
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98499-8368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-983-1539
-----------------------------------------------------
Fax | 253-588-2693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRICT NURSE PRACTITIONER
-----------------------------------------------------
Name | JEFFREY W THURSTON
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 253-983-1539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP 30002150
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------