Individual
JACLYN BLAIR THORNTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
PAIN SPECIALIST IT SOUTHERN OREGON, 825 BENNETT AVE, MEDFORD, OR 97504
(541) 779-5228
Mailing address
9 CLAIRE DR, HILTON HEAD ISLAND, SC 29928-3937
(901) 485-3766
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
10003878
OR
363LP2300X
Primary Care Nurse Practitioner
22326
SC
Other
Enumeration date
10/19/2018
Last updated
03/10/2023
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