Active NPI
Ellis Ray Tackett III, ATC LAT
- Specialist
- Pikeville, KY
National Provider Identifier
1821489576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- AT1092
- Practice address
- 147 Sycamore St
Pikeville, KY 41501-9118 - Phone
- (606) 213-1620
- Fax
- (606) 218-5353
- NPI assigned
- Feb 16, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | AT1092 | KY | Primary |
Addresses
Primary practice location
147 Sycamore St
Pikeville, KY 41501-9118
Mailing address
680 Hambley Blvd Apt 407
Pikeville, KY 41501-3804
Phone (606) 213-1620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT1092 | KY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424044800000",
"number": "1821489576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 HAMBLEY BLVD APT 407",
"city": "PIKEVILLE",
"state": "KY",
"postal_code": "415013804",
"telephone_number": "606-213-1620",
"fax_number": "606-218-5353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "147 SYCAMORE ST",
"city": "PIKEVILLE",
"state": "KY",
"postal_code": "415019118",
"telephone_number": "606-213-1620",
"fax_number": "606-218-5353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TACKETT",
"first_name": "ELLIS",
"middle_name": "RAY",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "ATC LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-16",
"last_updated": "2015-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "KY",
"license": "AT1092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pikeville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.