Provider Demographics
NPI:1902058068
Name:THORNTON, KRISTEN DANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:DANN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MICHELLE
Other - Last Name:DANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:3RD FLOOR - INTERVENTIONAL CARDIOLOGY
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-3727
Mailing Address - Fax:504-838-8853
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:3RD FLOOR - INTERVENTIONAL CARDIOLOGY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3727
Practice Address - Fax:504-838-8853
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200474.RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2167561Medicaid
MS09035221Medicaid
MS09035221Medicaid