Provider Demographics
NPI:1831548247
Name:THACKER, ADRIAN SCOTT (FNP-C)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:SCOTT
Last Name:THACKER
Suffix:
Gender:M
Credentials:FNP-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2582
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-2582
Mailing Address - Country:US
Mailing Address - Phone:276-796-4411
Mailing Address - Fax:276-796-4587
Practice Address - Street 1:198 ROSS CARTER BLVD
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244-5117
Practice Address - Country:US
Practice Address - Phone:276-690-7161
Practice Address - Fax:276-690-7246
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024173601363LF0000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)