Individual
KELSEY MARIE THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 E ASHLAND AVE, MT ZION, IL 62549-1271
(217) 864-2665
(217) 864-8042
Mailing address
104 ASHLAND AVENUE, MT. ZION, IL 62549
(217) 864-2665
(217) 864-8042
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209015926
IL
Other
Enumeration date
04/27/2017
Last updated
04/27/2017
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