Provider Demographics
NPI:1255823068
Name:THORNBERRY, CHRISTIE ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:ANN
Last Name:THORNBERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CARPENTER
Other - Middle Name:ANN
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2000 SE BLUE PKWY STE 270B
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1029
Mailing Address - Country:US
Mailing Address - Phone:816-524-8488
Mailing Address - Fax:877-422-9013
Practice Address - Street 1:2000 SE BLUE PKWY STE 270B
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1029
Practice Address - Country:US
Practice Address - Phone:816-524-8488
Practice Address - Fax:877-422-9013
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78195363L00000X
MO2018020107363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner