Provider Demographics
NPI:1457498677
Name:TACKETT, VICKI SUE (RNC, ARNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:SUE
Last Name:TACKETT
Suffix:
Gender:F
Credentials:RNC, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1089
Mailing Address - Country:US
Mailing Address - Phone:859-734-2229
Mailing Address - Fax:
Practice Address - Street 1:900 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1089
Practice Address - Country:US
Practice Address - Phone:859-734-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2256P163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory