MEDICARE: CASEY THORNTON CRNP

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	363LF0000X	Family Nurse Practitioner	1-113748	AL

General Provider Information

NPI Number	:	1508416611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY THORNTON CRNP

Provider Business Mailing Address
First Line	:	370 SAINT LUKES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7108
Country	:	US
Telephone Number	:	334-213-3606
Fax Number	:	334-213-3608

Provider Business Practice Location Address
First Line	:	370 SAINT LUKES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7111
Country	:	US
Telephone Number	:	334-213-3606
Fax Number	:

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

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/30/2019

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