Individual
MS. MECHELE L. THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
415 MORRIS ST, SUITE 201, CHARLESTON, WV 25301-1842
(304) 388-7700
(304) 388-7755
Mailing address
415 MORRIS ST 201, CHARLESTON, WV 25301-1853
(304) 388-7700
(304) 388-7755
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
47680
WV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
47680
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810007981
—
WV
Enumeration date
11/28/2006
Last updated
05/17/2022
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