Individual
KIMBERLY BETH TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
20 MORNINGSIDE DR, WYNNE, AR 72396-2528
(870) 208-6987
Mailing address
20 MORNINGSIDE DR, WYNNE, AR 72396-2528
(870) 208-6987
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R77061
AR
Other
Enumeration date
05/22/2013
Last updated
05/22/2013
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