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Individual

JACLYNN MARIE THACKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APRN, NP-C

Contact information

Practice address
420 W LONGEST ST, PAOLI, IN 47454-8821
(812) 723-3944
Mailing address
420 W LONGEST ST, PAOLI, IN 47454-8821
(812) 723-3944

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71011761A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300058325
IN
Enumeration date
09/17/2021
Last updated
07/24/2024
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