| NPI | 1871201285 |
|---|---|
| Former Name | MACY MARIE TACKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0035112) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: OH RN.453033) |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2023-11-18 |