Individual
JENNIFER L TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11675 JOLLYVILLE RD STE 207, AUSTIN, TX 78759-4105
(512) 856-1000
(317) 888-1591
Mailing address
11675 JOLLYVILLE RD STE 207, AUSTIN, TX 78759-4105
(512) 856-1000
(317) 888-1591
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000840A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8Y9381
BC/BS
TX
Enumeration date
06/16/2006
Last updated
01/09/2024
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