Individual provider Active NPI

Leisa Thornhill, RN,BSN,MSN,FNP-C

  • Family Nurse Practitioner
  • Abilene, TX
National Provider Identifier
1053741678
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
652655 Issued in TX
Practice address
1857 Pine St Ste 100
Abilene, TX 79601-2429
Phone
(325) 672-5601
Fax
(325) 672-1333
NPI assigned
Nov 18, 2013
Last updated
Jul 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 652655 TX Primary
Adult Medicine Physician 207QA0505X AP124532 TX

Addresses

Primary practice location

1857 Pine St Ste 100
Abilene, TX 79601-2429

Mailing address

1857 Pine St Ste 100
Abilene, TX 79601-2429
Phone (325) 672-5601

Other names 1

  • Leisa Clayton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140321001672 TX Practitioner - Nurse Practitioner 6103057815 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
AP124532TXMDAdult Medicine Physician
652655TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Employee Assistance Program Inc CurrentSince Apr 16, 2018 Accepting new patients
Regional Employee Assistance Program Inc CurrentSince Apr 16, 2018 Accepting new patients
Regional Employee Assistance Program Inc Current Accepting new patients
Regional Employee Assistance Program Inc Past Accepting new patients
Shannon Clinic PastSince Mar 1, 2014 Accepting new patients

Locations

3501 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 947-6361

3535 Knickerbocker Rd
San Angelo, TX 76904
Phone (915) 947-6495

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1053741678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1857 PINE ST STE 100",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796012429",
            "telephone_number": "325-672-5601",
            "fax_number": "325-672-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1857 PINE ST STE 100",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796012429",
            "telephone_number": "325-672-5601",
            "fax_number": "325-672-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORNHILL",
        "first_name": "LEISA",
        "credential": "RN,BSN,MSN,FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-18",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "652655",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "AP124532",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEISA",
            "last_name": "CLAYTON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Abilene, TX

Sources for this page

Verify at the official NPI Registry.