MEDICARE: MRS. SARAH A. THORNTON APN

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	363LG0600X	Gerontology Nurse Practitioner	AO1328	AR

General Provider Information

NPI Number	:	1588760334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH A. THORNTON APN

Provider Business Mailing Address
First Line	:	3035 NUTTER CHAPEL RD
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8379
Country	:	US
Telephone Number	:	501-450-9162
Fax Number	:	501-450-5560

Provider Business Practice Location Address
First Line	:	201 DONAGHEY AVE
Second Line	:	DHSC 226 J
City	:	CONWAY
State	:	AR
Zip	:	72035-5001
Country	:	US
Telephone Number	:	501-450-3119
Fax Number	:	501-450-5560

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	06/23/2008

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