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General NPI Number Information
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NPI Number | 1265878789
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Entity Type | Individual
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Provider Name | AMY R THORNE DO
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Gender | Female
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 110 BUSINESS PARK DR STE C
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City | BRANSON
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State | MO
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Zip | 65616-7449
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Country | US
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Telephone | 417-336-0033
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1506
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City | ARDMORE
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State | OK
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Zip | 73402-1506
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Country | US
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Telephone |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2016034327
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | R3974
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 6265
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License Number State | OK
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