Provider Demographics
NPI:1669553939
Name:TACKITT, HELEN (NP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:TACKITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-2312
Mailing Address - Country:US
Mailing Address - Phone:919-568-0004
Mailing Address - Fax:
Practice Address - Street 1:302 W GRAHAM ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2312
Practice Address - Country:US
Practice Address - Phone:919-568-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.430379363LF0000X
NC226622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2593350OtherMEDICARE
NC7004396Medicaid
Q76399Medicare UPIN