Provider Demographics
NPI:1083118673
Name:JONES-TACKETT, RACHEL ANDREA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANDREA
Last Name:JONES-TACKETT
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 CUMBERLAND AVE STE B102
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2614
Mailing Address - Country:US
Mailing Address - Phone:606-248-7778
Mailing Address - Fax:
Practice Address - Street 1:3602 CUMBERLAND AVE STE B102
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2614
Practice Address - Country:US
Practice Address - Phone:606-248-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012178208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics