Jerrigail Tackett
Individual provider Active NPI Counselor · West Liberty, KY
NPI 1831754894 · NPPES record last updated May 6, 2019
Key facts
- NPI
- 1831754894
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 767 Main St
West Liberty, KY 41472-1019 - Phone
- (606) 743-3139
- Fax
- (606) 743-4336
- NPI assigned
- May 6, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
767 Main St
West Liberty, KY 41472-1019
Mailing address
PO Box 790
Ashland, KY 41105-0790
Phone (606) 329-8588
Other providers in West Liberty, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.