Individual
DAVID THOMAS TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
20 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-5401
(859) 578-5880
(859) 578-5881
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 578-5880
(859) 578-5881
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1136773
KY
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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