Provider Demographics
NPI:1467988527
Name:THACKER, TAMMY JUNE (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JUNE
Last Name:THACKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HALF MOON RD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-6105
Mailing Address - Country:US
Mailing Address - Phone:865-617-7803
Mailing Address - Fax:865-435-2381
Practice Address - Street 1:206 HALF MOON RD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-6105
Practice Address - Country:US
Practice Address - Phone:865-617-7803
Practice Address - Fax:865-435-2381
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44150164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse