Healthcare Provider Details

I. General information

NPI: 1174173538
Provider Name (Legal Business Name): BRITTANY TACKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CHURCH ST STE 101
PIKEVILLE KY
41501-3476
US

IV. Provider business mailing address

PO BOX 726
LOUISA KY
41230-0726
US

V. Phone/Fax

Practice location:
  • Phone: 606-260-8613
  • Fax: 859-977-2683
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013582
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: