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NPI Code Detail

MEDICARE: STACY THORNLEY FNP

MEDICARE: STACY THORNLEY FNP
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
1363LF0000XFamily Nurse Practitioner317682AZ
22085R0204XVascular & Interventional Radiology Physician317682AZ

General Provider Information

NPI Number : 1477379121
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY THORNLEY FNP
Provider Business Mailing Address
First Line : 18444 N 25TH AVE STE 310
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-1266
Country : US
Telephone Number : 928-777-9600
Fax Number : 855-449-5560
Provider Business Practice Location Address
First Line : 1840 N JASPER DR STE 2
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-1634
Country : US
Telephone Number : 866-974-2673
Fax Number : 480-499-8459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2024
Last Update Date : 03/17/2026

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Directions to “ STACY THORNLEY FNP” Practice Location

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