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General NPI Number Information
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NPI Number | 1114709110
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Entity Type | Individual
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Provider Name | ABIGAIL SULLIVAN THORNHILL CPNP - PC/AC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 114 N LEHMBERG RD
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City | COLUMBUS
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State | MS
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Zip | 39702-5554
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Country | US
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Telephone | 662-329-2955
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Fax |
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Provider Business Mailing Address
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Address Line | 5 PROFESSIONAL PLZ
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City | STARKVILLE
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State | MS
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Zip | 39759-1900
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Country | US
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Telephone | 662-323-0999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 906388
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License Number State | MS
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