Provider Demographics
NPI:1871586891
Name:THORNELL, JENNIFER (RPA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:THORNELL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KNIGHTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-7575
Mailing Address - Fax:845-333-7139
Practice Address - Street 1:38 CONCORD RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-3210
Practice Address - Country:US
Practice Address - Phone:845-333-6500
Practice Address - Fax:845-333-6501
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007682363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02479349Medicaid
NY02479349Medicaid
S78221Medicare UPIN