Individual
ANDREA P TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
222 MEDICAL CIR, MOREHEAD, KY 40351-1179
(606) 783-6500
Mailing address
222 MEDICAL CIR, MOREHEAD, KY 40351-1179
(606) 783-6500
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
270498
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
270498
KY MEDICAL LICENSE
KY
Enumeration date
05/28/2021
Last updated
05/28/2021
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