MEDICARE: DEBORAH SUE TACKETT

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1487074951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH SUE TACKETT

Provider Business Mailing Address
First Line	:	200 TECH CENTER DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-2747
Country	:	US
Telephone Number	:	865-637-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 LAKE BROOK BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1137
Country	:	US
Telephone Number	:	865-637-9711
Fax Number	:

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

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	03/23/2021

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