Provider Demographics
NPI:1306180534
Name:THACKER, CHRISTIE ROSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:ROSE
Last Name:THACKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:281 N LYERLY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2748
Mailing Address - Country:US
Mailing Address - Phone:423-693-2175
Mailing Address - Fax:
Practice Address - Street 1:281 N LYERLY ST STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2748
Practice Address - Country:US
Practice Address - Phone:423-693-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-10
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily