Provider Demographics
NPI:1497968473
Name:THAYER, NANCY LAURA (PAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LAURA
Last Name:THAYER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:8442 HWY 107 NORTH
Mailing Address - City:GLENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28736-0195
Mailing Address - Country:US
Mailing Address - Phone:828-743-4136
Mailing Address - Fax:828-743-4136
Practice Address - Street 1:176 WALMART PLAZA
Practice Address - Street 2:SYLVA URGENT CARE
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28879
Practice Address - Country:US
Practice Address - Phone:828-631-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1700363A00000X
NC0010-03237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292781100Medicaid
AE298YMedicare PIN
AE298ZMedicare PIN