Individual
MARK A. TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2025 W EVERLY BROTHERS BLVD, POWDERLY, KY 42367-5401
(270) 377-2600
(270) 377-2610
Mailing address
PO BOX 23229, OWENSBORO, KY 42304-3229
(270) 688-1330
(270) 688-1338
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35646
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6401849200
—
KY
Enumeration date
03/31/2006
Last updated
05/14/2019
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