Individual
BENJAMIN TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
140 STOLLINGS AVE STE 1, LOGAN, WV 25601-4035
(304) 752-2555
Mailing address
140 STOLLINGS AVE STE 1, LOGAN, WV 25601-4035
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
66717
WV
Other
Enumeration date
08/25/2017
Last updated
08/25/2017
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