Individual
HEATHER D. TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3801 S NATIONAL AVE, WEST TOWER, SUITE 700, SPRINGFIELD, MO 65807-5210
(417) 885-3888
(417) 881-7268
Mailing address
PO BOX 4024, SPRINGFIELD, MO 65808-4024
(417) 885-3888
(417) 881-7268
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2007003918
MO
363AS0400X
Surgical Physician Assistant
Primary
2007003918
MO
363AS0400X
Surgical Physician Assistant
PA-405
AR
Other
Enumeration date
04/19/2007
Last updated
09/30/2021
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