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1104882083
JIM R TACKETT
LEXINGTON, KY
NPI
1104882083
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: KY PA553)
Enumeration Date
2006-04-21
Last Update Date
2011-02-24
Business Address
Mr. JIM R TACKETT PA-C
1101 VETERANS DR
LEXINGTON, KY 40502-2235
Phone number: 859-233-4511
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Mailing Address
Mr. JIM R TACKETT PA-C
2150 ELMFORK RD
NICHOLASVILLE, KY 40356-9619
Phone number: 859-887-9163
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