Individual
KRISTA THORNBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 344-4035
(260) 969-9272
Mailing address
6435 W JEFFERSON BLVD PMB 109, FORT WAYNE, IN 46804-6203
(260) 344-4035
(260) 969-9272
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71007032A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN.372896
OH
Other
Enumeration date
02/29/2016
Last updated
08/05/2020
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