Basic Information
| Provider Information | |||||||||
| NPI: | 1205139631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THACKER | ||||||||
| FirstName: | DANNY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 279 KINGS DAUGHTERS DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | FRANKFORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 406016561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028759885 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 279 KINGS DAUGHTERS DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | FRANKFORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 406016561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028759885 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2010 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA1619 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.