Provider Demographics
NPI:1396320701
Name:TACKETT, CHRISTOPHER RYAN
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:TACKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VENTERS LN
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3016
Mailing Address - Country:US
Mailing Address - Phone:606-653-1505
Mailing Address - Fax:
Practice Address - Street 1:400 VENTERS LN
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3016
Practice Address - Country:US
Practice Address - Phone:606-653-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)