Individual
KIMBERLY DAWN TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
800 ROSE ST WHITNEY HENDRICKSON BLDG RM 306, LEXINGTON, KY 40536-1129
(859) 323-4325
(859) 257-0661
Mailing address
PO BOX 3939, MIDWAY, KY 40347-3939
(859) 221-9532
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
107466
KY
Other
Enumeration date
12/07/2018
Last updated
03/28/2023
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