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General NPI Number Information
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NPI Number | 1952033979
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Entity Type | Individual
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Provider Name | LACI L THORNTON MSN, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 105 BROADWAY ST
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City | VINCENNES
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State | IN
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Zip | 47591-1251
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Country | US
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Telephone | 812-790-2599
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Fax |
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Provider Business Mailing Address
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Address Line | 15549 LAKE LAWRENCE RD
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City | LAWRENCEVILLE
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State | IL
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Zip | 62439-4722
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Country | US
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Telephone | 618-928-1530
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71013870A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 041348592
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209026582
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 28177544A
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License Number State | IN
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