Individual
KENNETH LEE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, CNP
Contact information
Practice address
4300 DUNLAVY ST APT 5118, HOUSTON, TX 77006-5441
(601) 927-7224
Mailing address
4300 DUNLAVY ST APT 5118, HOUSTON, TX 77006-5441
(601) 927-7224
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1032032
TX
Other
Enumeration date
03/29/2021
Last updated
03/29/2021
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