Provider Demographics
NPI:1588311062
Name:THORNTON, TAYLORE A
Entity type:Individual
Prefix:
First Name:TAYLORE
Middle Name:A
Last Name:THORNTON
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 1:469 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-5520
Mailing Address - Country:US
Mailing Address - Phone:314-689-6767
Mailing Address - Fax:
Practice Address - Street 1:469 CHELSEA DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-5520
Practice Address - Country:US
Practice Address - Phone:314-680-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver