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General NPI Number Information
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NPI Number | 1316536063
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Entity Type | Individual
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Provider Name | KRISTEN LEIGH THACKER RN
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Gender | Female
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 330 25TH ST
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City | ASHLAND
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State | KY
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Zip | 41101-7820
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Country | US
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Telephone | 66-329-8588
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 ADAMS AVE
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City | HUNTINGTON
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State | WV
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Zip | 25704-1334
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Country | US
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Telephone | 740-357-9155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.162430
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.174239
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 98443
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 98443
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License Number State | KY
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