| Doctor Name: | JEANNE DIANE THACKER |
| NPI Number: | 1962479774 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN CNS, FNP-C |
| License Number: | 573554 |
| Business Practice Address: | 1050 State Highway 16 S Bandera, TX - 780034830 |
| Business Phone Number: | 8307967713 |
| Business Fax Number: | |
| Mailing Address: | 1050 State Highway 16 S, BANDERA |
| State: | TX |
| Postal Code: | 780034830 |
| Phone Number: | 8307967713 |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2006 |
| NPI Last Update Date: | 12/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SA2200X |
| License Number: | 573554 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |