Provider Demographics
NPI:1417367848
Name:TACKETT, KRISTI LEANN (DO)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LEANN
Last Name:TACKETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LEANN
Other - Last Name:SENTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-430-2213
Mailing Address - Fax:606-432-4365
Practice Address - Street 1:184 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1518
Practice Address - Country:US
Practice Address - Phone:606-430-2213
Practice Address - Fax:606-432-4365
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine