Provider Demographics
NPI:1154106938
Name:THACKER, JAMES ERIC (RNFA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ERIC
Last Name:THACKER
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2796 KINGS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1174
Mailing Address - Country:US
Mailing Address - Phone:314-724-8961
Mailing Address - Fax:
Practice Address - Street 1:2796 KINGS CROSSING DR
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1174
Practice Address - Country:US
Practice Address - Phone:314-724-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029501163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant