MEDICARE: JULIA LEEANN THACKER APRN

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	363LF0000X	Family Nurse Practitioner	4023145	KY

General Provider Information

NPI Number	:	1932941515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA LEEANN THACKER APRN

Provider Business Mailing Address
First Line	:	733 GARRIOTT LN
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-9144
Country	:	US
Telephone Number	:	859-325-1796
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 N COLLEGE ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1089
Country	:	US
Telephone Number	:	859-734-2229
Fax Number	:

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

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	08/07/2025

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