Provider Demographics
NPI:1962408898
Name:THORN, TERRI (PA-C)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:THORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1303
Mailing Address - Country:US
Mailing Address - Phone:970-668-3633
Mailing Address - Fax:970-668-4406
Practice Address - Street 1:0018 COUNTY ROAD 1030
Practice Address - Street 2:SUITE 125
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-3633
Practice Address - Fax:970-668-5052
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1637363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96874279Medicaid
CO96874279Medicaid
COP80323Medicare UPIN