IndividualActive
Andrea Tackett, APRN
NPI 1114648060 · Nurse Practitioner · Edgewood, KY
Provider details
- NPI number
- 1114648060
- Entity type
- Individual
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- APRN
- Sex
- Female
- Sole proprietor
- No
- License
- 301668 (KY)
Mailing address
1 Medical Village Dr
Edgewood, KY 41017-3403
Registry dates
- Enumerated
- 2022-09-08
- Last updated
- 2022-11-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.