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General NPI Number Information
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NPI Number | 1336472711
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Entity Type | Individual
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Provider Name | ANGELA NICOLE THORN CPNP-PN
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Gender | Female
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 609 W COURT ST STE B
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City | WINNFIELD
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State | LA
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Zip | 71483-2686
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Country | US
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Telephone | 318-209-4646
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Fax | 318-209-4649
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Provider Business Mailing Address
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Address Line | 609 W COURT ST
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City | WINNFIELD
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State | LA
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Zip | 71483-2681
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Country | US
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Telephone | 318-623-2716
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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 | AP05870
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License Number State | LA
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