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General NPI Number Information
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NPI Number | 1952292674
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Entity Type | Individual
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Provider Name | RICHARD ALLEN THACKREY PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 301 SUDLAGER
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City | VILSEK
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State | BAVARRIA
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Zip | 92249
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Country | DE
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Telephone | 314-590-2368
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 411 BOX 3523
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City | APO
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State | AE
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Zip | 09112-0036
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Country | US
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Telephone | 270-268-3746
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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