Basic Information
| Provider Information | |||||||||
| NPI: | 1073567632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORN | ||||||||
| FirstName: | KERI | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 6TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598642634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066764441 | ||||||||
| FaxNumber: | 4066760835 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 6TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598642634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066764441 | ||||||||
| FaxNumber: | 4066760835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 10516 | MT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.