Individual provider Active NPI

Ashley Lilly Thacker, FNP-C

  • Family Nurse Practitioner
  • South Charleston, WV
National Provider Identifier
1679084628
Registry record updated Oct 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN71553-NP-C Issued in WV
Practice address
4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone
(304) 766-5650
NPI assigned
Oct 17, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN71553-NP-C WV Primary

Addresses

Primary practice location

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311

Mailing address

21 Michael St
Scott Depot, WV 25560-9534
Phone (304) 228-7291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250103001401 WV Practitioner - Nurse Practitioner 6305374307 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
THS Physician Partners IncGroup PAC ID 9537316393, 366 clinicians

Practice addresses (Care Compare)

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN71553-NP-CWVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
THS Physician Partners Inc Family CurrentSince Sep 27, 2024 Accepting new patients

Locations

L3539
Columbus, OH 43260
Phone (304) 414-4800

4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1679084628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 MICHAEL ST",
            "city": "SCOTT DEPOT",
            "state": "WV",
            "postal_code": "255609534",
            "telephone_number": "304-228-7291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091311",
            "telephone_number": "304-766-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "ASHLEY",
        "middle_name": "LILLY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "APRN71553-NP-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.