Jeanne Diane Thacker, MSN CNS, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

573554 Issued in TX

Practice address

1050 State Highway 16 S
Bandera, TX 78003-4830

Phone

(830) 796-7713

NPI assigned

Mar 1, 2006

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist, Master of Science - Nursing, Nurse Practitioner

State licenses

• Jeanne Diane Thacker-Andrade Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 17, 2010.

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292544000000",
    "number": "1962479774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 STATE HIGHWAY 16 S",
            "city": "BANDERA",
            "state": "TX",
            "postal_code": "780034830",
            "telephone_number": "830-796-7713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 STATE HIGHWAY 16 S",
            "city": "BANDERA",
            "state": "TX",
            "postal_code": "780034830",
            "telephone_number": "830-796-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "JEANNE",
        "middle_name": "DIANE",
        "credential": "MSN CNS, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2010-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "573554",
            "primary": true
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "TX",
            "license": "573554",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1962479774",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER ISSUED BY CMS 1/2005",
            "identifier": "8D0453",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNE",
            "last_name": "THACKER-ANDRADE",
            "middle_name": "DIANE",
            "credential": "MSN CNS, FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Bandera, TX
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.