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General NPI Number Information
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NPI Number | 1649654880
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Entity Type | Individual
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Provider Name | JOYCE DENISE THACKER APRN-AG
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Gender | Female
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 989 GOVERNORS LN STE 180
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City | LEXINGTON
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State | KY
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Zip | 40513-1174
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Country | US
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Telephone | 859-274-2296
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 MCCROSKEY DRIVE
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City | MOUNT STERLING
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State | KY
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Zip | 40353
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Country | US
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Telephone | 859-274-2296
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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 | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | 3009100
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 3009100
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 3009100
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License Number State | KY
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