Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Michael David Thacker, FNP-C

Individual provider Family Nurse Practitioner · NPI 1205399508

Michael David Thacker, FNP-C is a Nurse Practitioner in Johnson City, Tennessee. Qualified in 2018, 8 years ago. Works from 2 locations and accepts Medicare assignment. Licensed in Tennessee and Virginia.

Years since qualifying
8
Licensed in
TN, VA
In the registry since
2019
Specialties on file
2
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

403 Princeton Rd Ste 3
Johnson City, TN 37601-2040
Phone: (423) 302-3681
Fax: (423) 302-3689
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 100 Clinchfield St, Kingsport, TN 37660-3681 — (423) 247-7111

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 25386 (TN)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 00241777354 (VA)

Record details

NPI number1205399508
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedApril 12, 2019
Last updated in NPPESMay 5, 2026
Certification dateMay 5, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Johnson City