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General NPI Number Information
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NPI Number | 1134458243
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Entity Type | Individual
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Provider Name | TONI T TACKETT APRN
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Gender | Female
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Dates
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Enumeration Date | 12/18/2009
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 450 W LOCKE ST
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City | ASHDOWN
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State | AR
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Zip | 71822-3326
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Country | US
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Telephone | 870-898-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 450 W LOCKE ST STE C
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City | ASHDOWN
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State | AR
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Zip | 71822-3326
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Country | US
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Telephone | 870-898-4100
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Fax | 870-898-4136
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A003233
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License Number State | AR
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