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Individual

JENNIFER MARIE TACKITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
1821 LECLERC RD N STE 1, CUSICK, WA 99119-5015
(509) 447-7111
Mailing address
15827 E FRIDEGER RD, ELK, WA 99009-7009
(509) 292-0417

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP60883510
WA

Other

Enumeration date
07/31/2018
Last updated
07/31/2018
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