MEDICARE: VICKI SUE TACKETT R.N.C., ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0101X	Ambulatory Women's Health Care Registered Nurse	2256P	KY

General Provider Information

NPI Number	:	1457498677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI SUE TACKETT R.N.C., ARNP

Provider Business Mailing Address
First Line	:	900 N COLLEGE ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1089
Country	:	US
Telephone Number	:	859-734-2229
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 N COLLEGE ST
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1089
Country	:	US
Telephone Number	:	859-734-2229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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