Individual
JONATHAN MARK TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1279 OLD ABBOTT MOUNTAIN RD, PRESTONSBURG, KY 41653-1889
(606) 886-1260
(606) 886-3590
Mailing address
PO BOX 1595, ASHLAND, KY 41105-1595
(606) 408-6200
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03794
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0160277
—
OH
05
—
7100406690
—
KY
Enumeration date
06/06/2012
Last updated
02/07/2017
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