Individual
AMANDA JO TACKITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
920 UNIVERSITY ST, MARTIN, TN 38237-1605
(931) 588-5829
Mailing address
485 HUDSON SPRING RD, DRESDEN, TN 38225-1717
(731) 364-5616
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
57926
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57925
LPN
TN
Enumeration date
07/17/2013
Last updated
07/17/2013
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