| Doctor Name: | MRS. SHANNON TAYLOR THURSTON |
| NPI Number: | 1821243684 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 7154120-1206 |
| Business Practice Address: | 585 West Main Street Green River, UT - 84525 |
| Business Phone Number: | 4355643434 |
| Business Fax Number: | 4355643214 |
| Mailing Address: | Po Box 417, GREEN RIVER |
| State: | UT |
| Postal Code: | 845250417 |
| Phone Number: | 4355643434 |
| Fax Number: | 4355643214 |
| NPI Enumeration Date: | 11/20/2008 |
| NPI Last Update Date: | 01/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 7154120-1206 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |