Individual
MRS. MACY MARIE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, PMHNP-BC
Contact information
Practice address
3094 W MARKET ST STE 360, FAIRLAWN, OH 44333-3618
(614) 987-8847
Mailing address
6063 S MYERS RD, NEW FRANKLIN, OH 44216-9441
(330) 936-7653
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
RN.453033
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.0035112
OH
Other
Enumeration date
11/14/2022
Last updated
11/18/2023
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