Katrina Tackett

Primary specialty

Nurse's AideTaxonomy code 376K00000X

Practice address

637 A Mohawk Dr
Lucasville, OH 45648-8985

Phone

(740) 250-6699

NPI assigned

Dec 1, 2021

Last updated

Dec 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1922766583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 A MOHAWK DR",
            "city": "LUCASVILLE",
            "state": "OH",
            "postal_code": "456488985",
            "telephone_number": "740-250-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 A MOHAWK DR",
            "city": "LUCASVILLE",
            "state": "OH",
            "postal_code": "456488985",
            "telephone_number": "740-250-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "KATRINA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591052",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Dawn Sotelo
• Tracy L Strickland, LPTA
• Gary Svrakic Surak, MD
• Dannette Swain, RN, ADN
• Donna Marie Tackett
• Kimberly Tackett
• Tandem Health Care of Lucasville I, Inc. (Edgewood of Lucasville I)
• Tandem Health Care of Lucasville II, Inc. (Edgewood Manor of Lucasville II)
• Trinity Faith Thomas
• Vickie S Toller

• Nurse's Aide in Lucasville, OH
• Providers in Lucasville, OH by specialty
• Nurse's Aide in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.