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1003113648 NPI number — RENITA JOYCE TACKETT LPCC

NPI Number: 1003113648
Health Care Provider/Practitioner: RENITA JOYCE TACKETT LPCC

Information about “1003113648” NPI (RENITA JOYCE TACKETT LPCC) exists in 1003113648 in HTML format HTML  |  1003113648 in plain Text format TXT  |  1003113648 in PDF (Portable Document Format) PDF  |  1003113648 in an XML format XML  formats.

NPI Number : 1003113648 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003113648",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TACKETT",
    "FirstName": "RENITA",
    "MiddleName": "JOYCE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "155 LITTLE CREEK ROAD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PIKEVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "41501",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "606-639-2969",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "146 CHURCH OF CHRIST WAY",
    "SecondLinePracticeLocationAddress": "FORDS BRANCH CHURCH OF CRIST",
    "PracticeLocationAddressCityName": "PIKEVILLE",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "41501-8944",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "606-213-7830",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/17/2011",
    "LastUpdateDate": "08/20/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": "KY1031",
        "LicenseNumberStateCode": "KY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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