Provider Demographics
NPI:1144093808
Name:THOMURE, NATASHA TAYLOR
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:TAYLOR
Last Name:THOMURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 SLOAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-6894
Mailing Address - Country:US
Mailing Address - Phone:314-550-2171
Mailing Address - Fax:
Practice Address - Street 1:1843 E HIGHLAND DR STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6118
Practice Address - Country:US
Practice Address - Phone:870-277-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86371614133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered