MEDICARE: REBECCA L TACKETT ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3003239	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447277934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L TACKETT ARNP

Provider Business Mailing Address
First Line	:	1955 DIXIE HWY
Second Line	:	SUITE D
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-2792
Country	:	US
Telephone Number	:	859-341-5757
Fax Number	:	859-426-7134

Provider Business Practice Location Address
First Line	:	1955 DIXIE HWY
Second Line	:	SUITE D
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-2792
Country	:	US
Telephone Number	:	859-341-5757
Fax Number	:	859-426-7134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/05/2014

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