MEDICARE: NOAH N THACKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant		WV

General Provider Information

NPI Number	:	1316872195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH N THACKER

Provider Business Mailing Address
First Line	:	10 6TH AVE W
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1716
Country	:	US
Telephone Number	:	304-525-8014
Fax Number	:	304-525-8026

Provider Business Practice Location Address
First Line	:	10 6TH AVE W
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1716
Country	:	US
Telephone Number	:	304-525-8014
Fax Number	:	304-525-8026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ NOAH N THACKER ” Practice Location

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