| NPI | 1790164705 |
|---|---|
| Former Name | TARA TACKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WV 34801) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN.130012-M-IV) |
| 164W00000X Licensed Practical Nurse (Licence: KY 2046163) | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |