Individual
MRS. WANDA F TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
162 SHARP PERKINS ROAD, JACKSBORO, TN 37757-0418
(423) 562-8351
(423) 562-1593
Mailing address
PO BOX 418, JACKSBORO, TN 37757-0418
(423) 562-8351
(423) 562-1593
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN0000029117
TN
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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