Healthcare Provider Details

I. General information

NPI: 1285548990
Provider Name (Legal Business Name): KYLEA TACKETT PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 BARNETT DR
BATESVILLE AR
72501-8994
US

IV. Provider business mailing address

398 BARNETT DR
BATESVILLE AR
72501-8994
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-6774
  • Fax: 870-793-1997
Mailing address:
  • Phone: 870-793-6774
  • Fax: 870-793-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: