MEDICARE: MRS. SHANE D. THORNTON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	AP131112	TX

General Provider Information

NPI Number	:	1114279726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANE D. THORNTON CRNA

Provider Business Mailing Address
First Line	:	4310 SCOTTSDALE LN
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2519
Country	:	US
Telephone Number	:	940-235-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 11TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4300
Country	:	US
Telephone Number	:	940-235-0242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	02/10/2026

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