Individual
ASHLEY LILLY THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 766-5650
Mailing address
21 MICHAEL ST, SCOTT DEPOT, WV 25560-9534
(304) 228-7291
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN71553-NP-C
WV
Other
Enumeration date
10/17/2017
Last updated
10/17/2017
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