KRISTA THORNBERRY (NPI# 1710347059) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710347059 |
| Entity Type | Individual |
| Full Name | KRISTA THORNBERRY |
| Credential | PMHNP-BC |
| Practice Address |
2200 Randallia Dr Fort Wayne IN 46805-4638 |
| Mailing Address |
6435 W Jefferson Blvd Pmb 109 Fort Wayne IN 46804-6203 |
| Practice Telephone | 2603444035 |
| Practice Fax Number | 2609699272 |
| Mailing Telephone | 2603444035 |
| Mailing Fax Number | 2609699272 |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2020-08-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
71007032A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RN.372896 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 125 Executive Dr, Marion, OH 433026285 | 7403873087 |
| Street Address |
2200 RANDALLIA DR |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-4638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972508471 | Matthew Paul Ziccardi | Clinical Neuropsychologist | 2200 Randallia Dr, Fort Wayne, IN 46805 | 2005-06-20 |
| 1891308896 | Cameron Buzzard | Physical Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-08-28 |
| 1558985945 | Morgan Taylor Hilbert | Pharmacist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-06-02 |
| 1952941908 | Lydia Hentz | Counselor | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-01-07 |
| 1326683228 | Nicole Marie Gaunt | Social Worker | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-11-14 |
| 1205490877 | Elisha Lynn Handshoe | Physical Medicine & Rehabilitation | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-29 |
| 1154884898 | Monique Brissette | Speech-Language Pathologist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-10 |
| 1649733411 | Clarissa Burkett | Physical Therapy Assistant | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| 1740743533 | Ross Tyler Nelson | Physical Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| 1295298982 | Jennifer Ferguson | Occupational Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033742184 | Hamutyinei H Mamutse | Nurse Practitioner | 3512 Stellhorn Rd, Fort Wayne, IN 46815-4631 | 2020-02-18 |
| 1598395238 | Werner R Wolff | Nurse Practitioner | 700 Broadway, Fort Wayne, IN 46802-1402 | 2020-01-22 |
| 1083255855 | Melissa Ann Terry | Nurse Practitioner | 909 E State Blvd, Fort Wayne, IN 46805-3458 | 2019-10-03 |
| 1609437425 | Sherri Sue Albertson | Nurse Practitioner | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2019-06-24 |
| 1639103153 | Irene T Hoover | Nurse Practitioner | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548875669 | Brooke Lavignette | Nurse Practitioner | 1805 Summit Dr, West Lafayette, IN 47906-2231 | 2020-09-15 |
| 1205444775 | Anu Abraham Ade Owofadeju | Nurse Practitioner | 8820 S Meridian St Ste 225, Indianapolis, IN 46217-6064 | 2020-07-21 |
| 1356959068 | Indy Behavioral Health LLC | Nurse Practitioner | 2611 Waterfront Parkway East Dr Ste 370, Indianapolis, IN 46214-2069 | 2020-07-20 |
| 1942833306 | Osasumwen Igbinoba | Nurse Practitioner | 402 Wall St Ste 23, Valparaiso, IN 46383-2567 | 2020-02-13 |
| 1770114118 | Abbey Bolden | Nurse Practitioner | 929 Miller Ct, Greenfield, IN 46140-7267 | 2020-02-03 |
| 1376184556 | Carrie Mefford | Nurse Practitioner | 5435 E 16th St, Indianapolis, IN 46218-4869 | 2019-09-30 |
| 1700430006 | Lusine Vardanyan | Nurse Practitioner | Memorial Hospital and Health Care Center, 800 W 9th Street, Jasper, IN 47546-2514 | 2019-07-25 |
| 1134780851 | Eric Lyakhovetsky | Nurse Practitioner | 327 W Saidah Rd, Bloomington, IN 47404-8965 | 2019-06-24 |
| 1124599394 | Adria Dawn Thornburgh | Nurse Practitioner | 6235 Forest View Dr, Indianapolis, IN 46260-4707 | 2018-12-16 |
| 1033693213 | Katie Marie Feeney | Nurse Practitioner | Riley Children's Hospital, 705 Riley Hospital Dr, Indianapolis, IN 46202 | 2018-09-24 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on KRISTA THORNBERRY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.