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NPI Code Detail

MEDICARE: FAITH THACKERSON

MEDICARE: FAITH THACKERSON
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
1363LF0000XFamily Nurse Practitioner41438TN

General Provider Information

NPI Number : 1336087287
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAITH THACKERSON
Provider Business Mailing Address
First Line : 416 COPELAND ST
Second Line :
City : CLINTON
State : TN
Zip : 37716-4718
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10321 KINGSTON PIKE STE 114
Second Line :
City : KNOXVILLE
State : TN
Zip : 37922-3224
Country : US
Telephone Number : 865-333-6554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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