Jim R Tackett, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA553 Issued in KY

Practice address

1101 Veterans Dr
Lexington, KY 40502-2235

Phone

(859) 233-4511

NPI assigned

Apr 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298505600000",
    "number": "1104882083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 ELMFORK RD",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403569619",
            "telephone_number": "859-887-9163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 VETERANS DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405022235",
            "telephone_number": "859-233-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "JIM",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2011-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Lea Tabor, CRNA
• Melissa Tabor
• Amy E Tackett, PHARM D
• Chadwick Trei Tackett, MSN, FNP
• Jessica Faith Tackett, PHARMD
• Kayce Ann Tackett, MD
• Kimberly Dawn Tackett, LMT
• Madison Bailey Tackett, MD
• Madison Steffi Tackett, DO
• Reva Duff Tackett, MD

• Physician Assistant in Lexington, KY
• Providers in Lexington, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; 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.