MEDICARE: DR. ASHLEY AMELIA THAYER DNP, BSN, AGNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	61074479	WA
2	363LA2200X	Adult Health Nurse Practitioner	9136	MN
3	363LA2200X	Adult Health Nurse Practitioner	11961-33	WI
4	363LA2200X	Adult Health Nurse Practitioner	226686	AZ
5	363LA2200X	Adult Health Nurse Practitioner	308270	NY
6	363LA2200X	Adult Health Nurse Practitioner	95035009	CA

General Provider Information

NPI Number	:	1154947844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY AMELIA THAYER DNP, BSN, AGNP-BC

Provider Business Mailing Address
First Line	:	4354 MAPLETON RD
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-9652
Country	:	US
Telephone Number	:	716-807-2740
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 W 36TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-7902
Country	:	US
Telephone Number	:	888-803-3370
Fax Number	:	888-803-3331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2020
Last Update Date	:	04/20/2026

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