Individual provider Active NPI

Andrea Tackett, APRN

  • Nurse Practitioner
  • Edgewood, KY
National Provider Identifier
1114648060
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3016680 Issued in KY
Practice address
1 Medical Village Dr
Edgewood, KY 41017-3403
Phone
(859) 301-4000
NPI assigned
Sep 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 301668 KY
Nurse Practitioner 363L00000X 3016680 KY Primary

Addresses

Primary practice location

1 Medical Village Dr
Edgewood, KY 41017-3403

Mailing address

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 301-2237

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230224001708 KY Practitioner - Nurse Practitioner 5890168660 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Elizabeth Medical Center, IncGroup PAC ID 0648174623, 187 clinicians

Practice addresses (Care Compare)

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 301-4723

Hospital & facility affiliations

  • St Elizabeth Edgewood Hospital, Edgewood, KY, CCN 180035
  • St Elizabeth Ft Thomas Hospital, Fort Thomas, KY, CCN 180001
  • St Elizabeth Florence Hospital, Florence, KY, CCN 180045
  • St Elizabeth Dearborn Hospital Hospital, Lawrenceburg, IN, CCN 150086

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
301668KYMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
St Elizabeth Medical Center, Inc CurrentSince Oct 27, 2022 Accepting new patients
St Elizabeth Medical Center, Inc Nurse Practitioner CurrentSince Oct 27, 2022 Accepting new patients

Locations

1 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-2000

4900 Houston Rd
Florence, KY 41042
Phone (859) 212-5200

238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1114648060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-301-2237",
            "fax_number": "859-301-3962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-301-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "ANDREA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-08",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "301668",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3016680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.