Individual
KAYLA SHANE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, APRN
Contact information
Practice address
484 TOLLAGE CRK, PIKEVILLE, KY 41501-3305
(606) 230-2255
(606) 437-3001
Mailing address
484 TOLLAGE CRK, PIKEVILLE, KY 41501-3305
(606) 230-2255
(606) 437-3001
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4000516
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104521657
—
VA
05
—
1104521657
—
WV
05
—
7100894480
—
KY
Enumeration date
04/04/2023
Last updated
08/03/2023
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