Individual
DR. JESSICA RENEA TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
49 S BROADVIEW ST STE 1, GREENBRIER, AR 72058-8011
(501) 679-4030
Mailing address
49 S BROADVIEW ST STE 1, GREENBRIER, AR 72058-8011
(501) 679-4030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E9071
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
05/09/2012
Last updated
09/29/2015
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