Provider Demographics
NPI:1053577189
Name:THORNTON, SHELBY JEAN (APRN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:JEAN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JEAN
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-3114
Mailing Address - Fax:859-578-2156
Practice Address - Street 1:2300 CHAMBER CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-1673
Practice Address - Country:US
Practice Address - Phone:859-341-3114
Practice Address - Fax:859-578-2156
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00821192OtherRAILROAD MEDICARE
OH3085138Medicaid
KY7100077370Medicaid
KYP00726170OtherRAILROAD MEDICARE
OH3085138Medicaid
KY0387227Medicare PIN