Individual
CATHY SUE TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
142 DEPOT DR, SOUTH SHORE, KY 41175
(606) 932-2271
(606) 932-2273
Mailing address
PO BOX 550, VANCEBURG, KY 41179-0550
(606) 796-3029
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1083-NP
OH
363LF0000X
Family Nurse Practitioner
Primary
3007355
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3014811
—
OH
05
—
3810021969
—
WV
05
—
7100086830
—
KY
Enumeration date
08/24/2009
Last updated
03/22/2016
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