Provider Demographics
NPI:1861401028
Name:THORNHILL-SCOTT, FANNETTE (MD)
Entity type:Individual
Prefix:
First Name:FANNETTE
Middle Name:
Last Name:THORNHILL-SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N. HILLSIDE
Mailing Address - Street 2:BUILDING 1, 6TH FL
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214
Mailing Address - Country:US
Mailing Address - Phone:316-962-7422
Mailing Address - Fax:316-962-7805
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:BUILDING 1, 6TH FL
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:316-962-7422
Practice Address - Fax:316-962-7805
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS30201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100452250AMedicaid
KS6490OtherPHS
KS102815OtherBCBS
KS103699OtherHPK
KS138700OtherCOVENTRY
KS12149413OtherMULTIPLAN
KS102815OtherBCBS
KS102815Medicare ID - Type Unspecified