Individual
BRANDON TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 RAVENHILL DR STE 100&107, ATCHISON, KS 66002-9204
(913) 367-7300
(913) 674-2030
Mailing address
800 RAVENHILL DR, ATCHISON, KS 66002-9204
(913) 367-2131
(913) 674-2023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-37700
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16289050
PTAN
KS
05
—
30004478980001
—
KS
Enumeration date
05/29/2013
Last updated
03/20/2026
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