Individual
JESSICA RENEE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
571 PARKWAY DR, SALYERSVILLE, KY 41465-9248
(606) 349-6181
Mailing address
PO BOX 143, SHELBIANA, KY 41562-0143
(859) 537-2311
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
3013573
KY
363LF0000X
Family Nurse Practitioner
Primary
3013573
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3013573
KENTUCKY BOARD OF NURSING
KY
Enumeration date
07/14/2019
Last updated
03/30/2020
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