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NPI Code Detail

MEDICARE: CODY THORSON PA-C

MEDICARE: CODY THORSON PA-C
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
1363A00000XPhysician AssistantPA2581NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508519653
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODY THORSON PA-C
Provider Business Mailing Address
First Line : 650 S GREEN VALLEY PKWY STE 120
Second Line :
City : HENDERSON
State : NV
Zip : 89052-0425
Country : US
Telephone Number : 702-847-6252
Fax Number : 702-847-6254
Provider Business Practice Location Address
First Line : 1348 PASEO VERDE PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89012-5723
Country : US
Telephone Number : 702-847-6252
Fax Number : 702-847-6254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2022
Last Update Date : 03/03/2026

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Directions to “ CODY THORSON PA-C” Practice Location

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