Individual
ANDREA JO TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2500 STATE ROUTE 5, ASHLAND, KY 41102-9102
(606) 408-4000
Mailing address
PO BOX 1595, ASHLAND, KY 41105-1595
(606) 408-9571
(606) 408-6061
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
3013898
KY
Other
Enumeration date
10/22/2019
Last updated
09/15/2020
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