1447238357 NPI number — MRS. SHEILA ELAINE THORNSBERRY PAC

Table of content: MRS. SHEILA ELAINE THORNSBERRY PAC (NPI 1447238357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447238357 NPI number — MRS. SHEILA ELAINE THORNSBERRY PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNSBERRY
Provider First Name:
SHEILA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BANKS
Provider Other First Name:
SHEILA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447238357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 DOVE RUN RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-269-4668
Provider Business Mailing Address Fax Number:
859-266-5577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 DOVE RUN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-269-4668
Provider Business Practice Location Address Fax Number:
859-266-5577
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA254 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA254 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 95000154 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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