| Doctor Name: | MR. THOMAS ALVIS THACKER |
| NPI Number: | 1922251123 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA1164 |
| Business Practice Address: | 1134 Main St Munfordville Munfordville, KY - 427659432 |
| Business Phone Number: | 2705243641 |
| Business Fax Number: | 2705247595 |
| Mailing Address: | Po Box 340, 1134 Main Street MUNFORDVILLE |
| State: | KY |
| Postal Code: | 427650340 |
| Phone Number: | 2705243641 |
| Fax Number: | 2705247595 |
| NPI Enumeration Date: | 10/31/2008 |
| NPI Last Update Date: | 01/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA1164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |