Individual
ANDREA TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-4000
Mailing address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2237
(859) 301-3962
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3016680
KY
363LF0000X
Family Nurse Practitioner
301668
KY
Other
Enumeration date
09/08/2022
Last updated
11/03/2022
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