Individual
MR. JIM R TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1101 VETERANS DR, LEXINGTON, KY 40502-2235
(859) 233-4511
Mailing address
2150 ELMFORK RD, NICHOLASVILLE, KY 40356-9619
(859) 887-9163
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA553
KY
Other
Enumeration date
04/21/2006
Last updated
02/24/2011
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