Individual
TIMOTHY K. THURSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
225 MEDICAL CENTER DR, SUITE 303, PADUCAH, KY 42003-7914
(270) 442-9463
(270) 442-2241
Mailing address
PO BOX 636961, CINCINNATI, OH 45263-6961
(513) 981-5130
(513) 981-5015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA154
KY
363AM0700X
Medical Physician Assistant
PA154
KY
363AS0400X
Surgical Physician Assistant
085000805
IL
363AS0400X
Surgical Physician Assistant
PA 154
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100183160
—
KY
01
—
P01012695
RAIL ROAD MEDICARE
KY
Enumeration date
10/03/2005
Last updated
09/25/2024
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