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Individual
JASON PRESTON TACKETT
Active
Individual
JASON PRESTON TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041188540
IL
163W00000X
Registered Nurse
28164172A
IN
363L00000X
Nurse Practitioner
209012575
IL
363L00000X
Nurse Practitioner
Primary
71003469A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201012930
—
IN
Enumeration date
08/24/2010
Last updated
04/21/2025
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