Individual
MRS. KENDALL SHEA THORNTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1616 WILLIAMS DR, LEAKESVILLE, MS 39451-5622
(601) 394-2381
(601) 394-2593
Mailing address
940 MATTHEW DR, STE 2, WAYNESBORO, MS 39367-2573
(601) 394-2381
(601) 394-2593
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R876172
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R876172
STATE LICENSE NUMER
MS
Enumeration date
01/27/2012
Last updated
01/28/2016
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