Individual
ALIVIA RAYE TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
840 GALLIA ST, PORTSMOUTH, OH 45662-4232
(740) 354-0700
(740) 876-8691
Mailing address
840 GALLIA ST, PORTSMOUTH, OH 45662-4232
(740) 354-0700
(740) 876-8691
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3016340
KY
Other
Enumeration date
09/13/2021
Last updated
10/24/2024
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