Healthcare Provider Details

I. General information

NPI: 1154106938
Provider Name (Legal Business Name): JAMES ERIC THACKER RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2796 KINGS CROSSING DR
BARNHART MO
63012-1174
US

IV. Provider business mailing address

2796 KINGS CROSSING DR
BARNHART MO
63012-1174
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax:
Mailing address:
  • Phone: 214-227-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2008029501
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: