Tackett, Jonathan Mark

Tackett, Jonathan Mark is an individual health care provider with primary practice located at 1279 Old Abbott Mountain Rd , Prestonsburg KY 41653-1889. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Tackett, Jonathan Mark can be contacted via phone (606) 886-1260.

Contact Information

Primary practice address
1279 Old Abbott Mountain Rd Prestonsburg KY 41653-1889
Phone: (606) 886-1260
Fax: (606) 886-3590
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 03794 Kentucky

Profile Details

NPI number 1922369974
LBN Legal business name Tackett, Jonathan Mark
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2012
Last updated Feb 7th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922369974 NPPES
Ohio MEDICAID 0160277
Ohio MEDICAID 7100406690

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