Individual
JULIE TUTTLE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1038 BETHANIA RURAL HALL RD, RURAL HALL, NC 27045-9552
(336) 716-9270
(336) 702-9313
Mailing address
PROVIDER ENROLLMENT, 100 KIMEL FOREST DRIVE, WINSTON SALEM, NC 27103-6074
(336) 713-0947
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5005790
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006330
—
NC
Enumeration date
09/11/2012
Last updated
12/07/2023
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