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General NPI Number Information
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NPI Number | 1760235329
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Entity Type | Individual
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Provider Name | TRACY LEE THORNTON DNP, CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 2807 GREYSTONE COMMERCIAL BLVD STE 32
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City | HOOVER
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State | AL
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Zip | 35242-9601
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Country | US
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Telephone | 205-783-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 1174 WASHINGTON DR
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City | MOODY
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State | AL
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Zip | 35004-6137
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Country | US
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Telephone | 256-777-6010
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-072797
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License Number State | AL
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