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Jordan Tackett

NPI Registration Record

Provider / OrganizationNPIDate Certified
JORDAN TACKETT11842223582020-10-11
Entity TypeIndividual
Provider NameDr. Jordan Tackett
Practice Office Address911 BYPASS RD BLDG E
PIKEVILLE, KY US
Practice Office Telephone6062183576
Mailing Address640 MARE CRK
STANVILLE, KY 416599000 US
HPT Codes
CodeLicense NoState
183500000X PRIMARY020231 KY
OPI Codes

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