Provider Demographics
NPI:1013893379
Name:THACKER, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:THACKER
Suffix:
Gender:F
Credentials:
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 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-9564
Mailing Address - Fax:606-408-6061
Practice Address - Street 1:617 23RD ST STE 105
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2890
Practice Address - Country:US
Practice Address - Phone:606-408-7500
Practice Address - Fax:606-408-6600
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009624RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant