| Doctor Name: | HEATHER THORNBURG |
| NPI Number: | 1467854463 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 177555 |
| Business Practice Address: | 1919 W Park Dr N Wilkesboro, NC - 286593564 |
| Business Phone Number: | 3366512980 |
| Business Fax Number: | 3366672047 |
| Mailing Address: | Po Box 751803, CHARLOTTE |
| State: | NC |
| Postal Code: | 282751803 |
| Phone Number: | 3366512980 |
| Fax Number: | 3366672047 |
| NPI Enumeration Date: | 09/22/2014 |
| NPI Last Update Date: | 12/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 177555 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |