Individual
TANYA TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
840 INTERSTATE DR, GRAYSON, KY 41143-1768
(606) 474-5151
Mailing address
840 INTERSTATE DR, GRAYSON, KY 41143-1768
(606) 474-5151
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2039581
KY
171M00000X
Case Manager/Care Coordinator
2039581
KY
Other
Enumeration date
04/05/2022
Last updated
02/28/2025
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