Individual
SAMUEL TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
133 SUSANNA RD, WAR, WV 24892-9001
(304) 875-2452
Mailing address
133 SUSANNA RD, WAR, WV 24892-9001
(304) 875-2452
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/27/2024
Last updated
02/27/2024
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