Provider Demographics
NPI:1447903539
Name:THURSTON, AMY KRISTINE (MSN, CPNP-PC, RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTINE
Last Name:THURSTON
Suffix:
Gender:F
Credentials:MSN, CPNP-PC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:3333 BROADWAY APT B18D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-8728
Mailing Address - Country:US
Mailing Address - Phone:303-241-4780
Mailing Address - Fax:
Practice Address - Street 1:15715 46TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2353
Practice Address - Country:US
Practice Address - Phone:718-445-3029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF383237-01363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics