Individual
JANET LYNN THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1101 S MAIN ST, KERNERSVILLE, NC 27284-7478
(336) 996-4021
Mailing address
1101 S MAIN ST, KERNERSVILLE, NC 27284-7478
(336) 996-4021
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5004244
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7004289
—
NC
Enumeration date
12/11/2008
Last updated
03/17/2018
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