Doctor Name: | JONATHAN M TACKETT |
NPI Number: | 1922369974 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 4004 Louisa Rd Catlettsburg, KY - 411291091 |
Business Phone Number: | 6067396095 |
Business Fax Number: | 6067398252 |
Mailing Address: | Po Box 1595, ASHLAND |
State: | KY |
Postal Code: | 411051595 |
Phone Number: | 6064086200 |
Fax Number: | 6064086612 |
NPI Enumeration Date: | 06/06/2012 |
NPI Last Update Date: | 03/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |