Tackman, Lori Anne

Tackman, Lori Anne is an individual health care provider with primary practice located at 20 Medical Campus Dr Nw Ste 205 , Supply NC 28462. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Tackman, Lori Anne can be contacted via phone (910) 721-4400.

Contact Information

Primary practice address
20 Medical Campus Dr Nw Ste 205 Supply NC 28462
Phone: (910) 721-4400
Fax: (910) 721-4409
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2000-00146 North Carolina

Profile Details

NPI number 1497752968
LBN Legal business name Tackman, Lori Anne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2005
Last updated Oct 26th, 2020 - about 6 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 1497752968 NPPES
North Carolina Other 126WX BCBS
North Carolina MEDICAID 89126WX BCBS

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