MEDICARE: CHRISTIE ROSE THACKER FNP-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	363LF0000X	Family Nurse Practitioner	16714	TN

General Provider Information

NPI Number	:	1306180534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE ROSE THACKER FNP-BC

Provider Business Mailing Address
First Line	:	281 N LYERLY ST STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-2748
Country	:	US
Telephone Number	:	423-693-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	281 N LYERLY ST STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-2748
Country	:	US
Telephone Number	:	423-693-2175
Fax Number	:

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

Provider Enumeration Date	:	11/10/2012
Last Update Date	:	05/17/2024

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Directions to “ CHRISTIE ROSE THACKER FNP-BC” Practice Location

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