Individual
ALLISON R. THORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
16 W. 4TH ST.,, GRANT CITY, MO 64456
(660) 564-3322
(660) 564-3324
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2005007476
MO
363L00000X
Nurse Practitioner
Primary
2001017678
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0599373
—
IA
01
—
1053452623
GRANT CITY CLINIC NPI
MO
05
—
427378807
—
MO
01
—
505708305
GC CLINIC MEDICAID
MO
01
—
L280000
GC CLINIC GROUP MEDICARE
MO
Enumeration date
06/04/2006
Last updated
11/10/2020
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