Individual
JEFFERY RAY TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, PPCNP-C
Contact information
Practice address
2650 N TENAYA WAY STE 308, LAS VEGAS, NV 89128-1102
(702) 870-2099
(702) 869-5347
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
18745
TN
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN002155
NV
Other
Enumeration date
06/04/2014
Last updated
11/03/2022
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