Individual
JOSEPH BRANDON TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1051 HIGHLAND COLONY PKWY, RIDGELAND, MS 39157-8843
(601) 707-3737
Mailing address
139 HAMPTON PL, MADISON, MS 39110-4546
(601) 260-2083
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903568
MS
363LF0000X
Family Nurse Practitioner
TACK-9YD0RY
MS
Other
Enumeration date
09/14/2019
Last updated
10/07/2019
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