Healthcare Provider Details

I. General information

NPI: 1114784865
Provider Name (Legal Business Name): TAYLOR THACKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 LINCOLN WAY STE A
CLINTON IA
52732-7229
US

IV. Provider business mailing address

1120 WILLANY DR
CLINTON IA
52732-3302
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-1413
  • Fax:
Mailing address:
  • Phone: 563-451-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA177749
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: