Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Robert Slade Thacker, APRNCFNP

Individual provider Family Nurse Practitioner · NPI 1124309224

Robert Slade Thacker, APRNCFNP is a Nurse Practitioner in Caldwell, Idaho. Qualified in 2004, 22 years ago. Practices with Saint Alphonsus Regional Medical Center Inc, a 673-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
22
Licensed in
ID
In the registry since
2011
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Practice location Address checks out

712 Aviation Way
Caldwell, ID 83605-1154
Phone: (208) 302-7100
Fax: (208) 302-7155
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1906 Fairview Ave, Caldwell, ID 83605-5407 — (208) 459-4667

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence NP-1096A (ID)

Record details

NPI number1124309224
Entity typeIndividual (Type 1)
GenderMale
Credentials APRNCFNP
Sole proprietorNo
NPI enumeratedSeptember 1, 2011
Last updated in NPPESAugust 7, 2025
Certification dateAugust 7, 2025
Mailing address1906 Fairview Ave, Ste. 230, Caldwell, ID 83605-5407

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Saint Alphonsus Regional Medical Center Inc — 673 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Caldwell