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General NPI Number Information
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NPI Number | 1447387139
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Entity Type | Individual
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Provider Name | SHERRY C TACKETT N.P.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10617 N HAYDEN RD SUITE B-102
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5578
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Country | US
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Telephone | 480-483-9011
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Fax | 480-483-9011
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Provider Business Mailing Address
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Address Line | 2236 E LINCOLN DR
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City | PHOENIX
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State | AZ
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Zip | 85016-1143
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Country | US
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Telephone | 602-432-2026
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Fax |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN052122
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License Number State | AZ
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