Individual provider Active NPI

Sylvia Joanna Tackett, PA-C

  • Physician Assistant
  • Jeffersonville, IN
National Provider Identifier
1083549802
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1220 Missouri Ave
Jeffersonville, IN 47130-3725
Phone
(812) 282-6631
NPI assigned
Jun 15, 2026
Sex
Female
Sole proprietor
No

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X KY Primary

Addresses

NPPES NPI Registry

Primary practice location

1220 Missouri Ave
Jeffersonville, IN 47130-3725

Mailing address

2494 Glen Eagle Dr
Louisville, KY 40222-6487
Phone (606) 477-1611

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 15, 2026.

{
    "created_epoch": "1781481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1083549802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2494 GLEN EAGLE DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402226487",
            "telephone_number": "606-477-1611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 MISSOURI AVE",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471303725",
            "telephone_number": "812-282-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "SYLVIA",
        "middle_name": "JOANNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-15",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jeffersonville, IN

Sources for this page

Verify at the official NPI Registry.