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MICHAEL DAVID THACKER FNP-C
NPI 1205399508
Nurse Practitioner - Family in Johnson City, TN

Active since April 12, 2019PECOS EnrolledAccepts Medicare Assignment
403 PRINCETON RD STE 3, JOHNSON CITY, TN 37601(423) 302-3681(423) 302-3689 Get Directions Write a Review

NPPES record last updated: May 5, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 5, 2026, Mar 20, 2025, Jun 20, 2019 and 1 more (4 updates tracked since 2019).

About Michael David Thacker Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICHAEL DAVID THACKER FNP-C (NPI 1205399508) is an individual family provider in Johnson City, Tennessee, licensed in Tennessee (25386) and active in the NPI registry since April 2019. He is enrolled in Medicare PECOS, maintains a secondary practice location in Kingsport, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1205399508
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameMICHAEL DAVID THACKERCredential: FNP-C
Location Address403 PRINCETON RD STE 3Johnson City, TN 37601-2040
Mailing Address1021 W Oakland Ave Ste 310Johnson City, TN 37604-2192 · (423) 952-2111
Phone(423) 302-3681
Fax(423) 302-3689
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateApril 12, 2019
Last NPPES UpdateMay 5, 20264 updates tracked since enumeration
NPPES CertifiedMay 5, 2026
✔ NPI 1205399508 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in TN · 25386✔ Licensed in VA · 00241777354
403 PRINCETON RD STE 3, Johnson City, TN 37601
Open in Google Maps ↗

Secondary Practice Location 1

Location 1100 Clinchfield StKingsport, TN 37660-3681 · Phone (423) 247-7111

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Michael David Thacker Fnp-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4486121167
PECOS Enrollment IDI20260430001196
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37601 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.53 typical visit price
range $52.64 – $160.89
Typical copayment $20.38 (range $13.16 – $40.22)
Most-billed visit code 99203
Established Patient
$93.60 typical visit price
range $16.72 – $131.41
Typical copayment $23.40 (range $4.18 – $32.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WENDI Y MINUTOLO
Behavior Analyst
403 PRINCETON RD STE 3
JOHNSON CITY, TN 37601
Washington County (423) 202-3622
KAYLI COWAN BCBA
Behavior Analyst
403 PRINCETON RD STE 3
JOHNSON CITY, TN 37601
Washington County (423) 202-3622
BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Preventive Medicine (Occupational Medicine)
403 PRINCETON RD STE 3
JOHNSON CITY, TN 37601
Washington County (423) 302-3681
MRS. SARAH N BIRDWELL
Behavior Analyst
403 PRINCETON RD STE 3
JOHNSON CITY, TN 37601
Washington County (423) 202-3622

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Thacker's NPI number?

The NPI number for Michael Thacker is 1205399508. It was assigned to this individual provider in the NPPES registry on April 12, 2019.

Where is Michael Thacker located?

Michael Thacker practices at 403 Princeton Rd Ste 3, Johnson City, TN 37601. The listed phone number is (423) 302-3681.

What is Michael Thacker's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Michael Thacker enrolled in Medicare?

Yes. Michael Thacker is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Michael Thacker was last updated on May 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.