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Individual

TRACI THORNSBURY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
104 LOGAN ST STE A, WILLIAMSON, WV 25661-3606
(304) 236-5902
Mailing address
PO BOX 2080, WILLIAMSON, WV 25661-2080
(304) 236-5902
(855) 487-4047

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
92307
WV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
92307
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100443080
KY
Enumeration date
07/18/2016
Last updated
01/03/2024
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