Kayla Shane Tackett, PMHNP-BC, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4000516 Issued in KY

Practice address

484 Tollage CRK
Pikeville, KY 41501-3305

Phone

(606) 230-2255

Fax

(606) 437-3001

NPI assigned

Apr 4, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kayla.tackett.1@19494.direct.athenahealth.com
• Direct secure messaging: kayla.tackett.2@19494.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Compassion Pediatrics of Wayland

  • Rural Health Clinic/Center
  • Wayland, KY
  • NPI 1922754290
  NPD (past)
• Compassion Services

  • Rural Health Clinic/Center
  • Pikeville, KY
  • NPI 1619642972
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1104521657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "484 TOLLAGE CRK",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013305",
            "telephone_number": "606-230-2255",
            "fax_number": "606-437-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 TOLLAGE CRK",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013305",
            "telephone_number": "606-230-2255",
            "fax_number": "606-437-3001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 Adams Ln Ste 300",
            "address_purpose": "LOCATION",
            "city": "Pikeville",
            "state": "KY",
            "postal_code": "415013088",
            "country_code": "US",
            "telephone_number": "606-230-2255",
            "fax_number": "606-437-3001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2643 King Kelly Coleman Hwy",
            "address_purpose": "LOCATION",
            "city": "Wayland",
            "state": "KY",
            "postal_code": "41666",
            "country_code": "US",
            "telephone_number": "606-531-4040",
            "fax_number": "606-284-2039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "KAYLA",
        "middle_name": "SHANE",
        "credential": "PMHNP-BC, APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-04",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "4000516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104521657",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100894480",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104521657",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Kalyn Grace Tackett
• Eva Mae Tackett
• Jereny S Tackett, BA MHA
• Jordan Tackett
• Kayla Danielle Tackett
• Kristi Leann Tackett, D.O.
• Laura Tackett, R.N.
• Matthew Brian Tackett, D.C.
• Michelle Tackett, R.D.H.
• Renita Joyce Tackett, LPCC

• Psychiatric/Mental Health Nurse Practitioner in Pikeville, KY
• Providers in Pikeville, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.