Individual
MS. STACY ANN TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, ANP-BC
Contact information
Practice address
3600 GASTON AVE, BARNETT TOWER, STE 605, DALLAS, TX 75246-1800
(214) 820-9248
(214) 820-9258
Mailing address
3600 GASTON AVE, BARNETT TOWER, STE 605, DALLAS, TX 75246-1800
(214) 820-9248
(214) 820-9258
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
595007
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3126120-01
—
TX
Enumeration date
11/19/2010
Last updated
04/12/2022
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