TARA L. TACKETT


Address: 400 Court St Ste 100, Charleston, WV 25301
Phone: 3043476120

TARA L. TACKETT (NPI# 1235585027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1235585027
Entity Type Individual
Full Name TARA L. TACKETT
Other Name TARA L. CROWDER
Credential APRN-CNP
Practice Address 400 Court St Ste 100
Charleston
WV 25301
Mailing Address 400 Court St Ste 100
Charleston
WV 25301-1652
Practice Telephone 3043476120
Practice Fax Number 3043476142
Mailing Telephone 3043476120
Mailing Fax Number 3043476142
Enumeration Date 2016-05-11
Last Update Date 2020-04-10
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363L00000X Nurse Practitioner APRN63856-NP-C WV Physician Assistants & Advanced Practice Nursing Providers
Y 363LF0000X Nurse Practitioner
Specialization: Family
APRN63856-NP-C WV Physician Assistants & Advanced Practice Nursing Providers
N 363LF0000X Nurse Practitioner
Specialization: Family
63856 WV Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
WV GROUP MEDICARE 9296571 01
WV GROUP MEDICAID 0011253000 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
1206 Hospital Dr, Hurricane, WV 255268708 3047575420 3047575421
3200 Maccorkle Ave Se, Charleston, WV 253041227 3043885432
3200 Maccorkle Ave Se, 4th Fl, Charleston, WV 25304 3043888240 3043888238
4605 Maccorkle Ave Sw, South Charleston, WV 253091311 3043063053 3043063054

Office Location

Street Address 400 COURT ST STE 100
City CHARLESTON
State WV
Zip Code 25301

Providers in the same location

NPI Name Taxonomy Address Enumeration
1346236072 Brad L Lindsey Anesthesiology 400 Court St Ste 100, Charleston, WV 25301-1652 2005-09-27
1962897272 Alyson Marie Engle Anesthesiology 400 Court St Ste 100, Charleston, WV 25301-1652 2015-04-02
1902243447 Rebecca Lynne Butcher Registered Nurse 400 Court St Ste 100, Charleston, WV 25301-1652 2013-05-23
1831116375 Center for Pain Relief, Inc. Anesthesiology 400 Court St Ste 100, Charleston, WV 25301-1652 2006-07-17
1780619742 Christopher Konkyo Kim Anesthesiology 400 Court St Ste 100, Charleston, WV 25301-1652 2006-07-11
1194759092 Carolyn Sue Poston Physical Therapist 400 Court St Ste 100, Charleston, WV 25301-1652 2006-07-10
1629002522 Mindy Beth Gardner Physical Therapist 400 Court St Ste 100, Charleston, WV 25301-1652 2006-07-10
1861424210 Timothy Ray Deer Anesthesiology 400 Court St Ste 100, Charleston, WV 25301-1652 2006-07-07
1972535367 Wilfrido T Tolentino Jr. Physician Assistant 400 Court St Ste 100, Charleston, WV 25301-1652 2006-07-07

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1669087680 Kerrie Rena Harris Counselor 16 Leon Sullivan Way Suite 300, Charleston, WV 25301 2020-09-15
1285123471 Burgess Dental Dentist 405 Capitol Street, The Parlor Suite, Charleston, WV 25301 2018-05-03
1104322320 Kara Caldwell Psychologist 333 Laidley St., 4'th Floor East, Charleston, WV 25301 2018-04-05
1740638022 Christina Phalen Pharmacy Technician 701 Lee Street East, Charleston, WV 25301 2016-05-27
1366867079 Brooke Powell Garnes Speech-Language Pathologist 1313 Quarrier Street, Suite A, Charleston, WV 25301 2014-03-04
1952648404 Implanted Pump Management, LLC Home Infusion 311 Laidley St., Suite 202, Charleston, WV 25301 2013-01-03
1730435108 Chaitanya Mishra Internal Medicine 501 Morris St Ste 357, Charleston, WV 25301 2012-08-03
1033477278 James Stephen Harman Neurological Surgery 415 Morris St Ste 400, Charleston, WV 25301 2012-04-25
1265674329 Howard and Howard Dental LLC Dentist 1321 Virginia St., Charleston, WV 25301 2009-04-03
1881856144 Steven David Hollosi Emergency Medicine 501 Morris St., Charleston, WV 25301 2008-06-27
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1417557737 Diondra Johnson Nurse Practitioner 2327 Watchtower Ln, Charleston, SC 29414-7803 2020-10-27
1427656735 Kisha Lanece James Nurse Practitioner 16 Red Mulberry Way Apt 3, Charleston, WV 25306-0107 2020-10-09
1043822216 Amber Bagwell Nurse Practitioner 442 King St Fl 2, Charleston, SC 29403-6230 2020-08-19
1790396273 Amanda Jo Grant Nurse Practitioner 2207 Seneca Dr, Charleston, IL 61920-3836 2020-08-10
1811514961 Isabel Margarita Lemasters Nurse Practitioner 3226 Moonlight Dr, Charleston, SC 29414-8052 2020-07-05
1255954566 Christina L. White Nurse Practitioner 1199 Persimmon Rd, Charleston, IL 61920 2020-05-20
1770123929 Catherine A. Woods Nurse Practitioner 9313 Medical Plaza Dr Ste 310, Charleston, SC 29406-9197 2020-01-15
1104464999 Brittany D Griffith Nurse Practitioner 830 Pennsylvania Ave Ste 402, Charleston, WV 25302-3390 2019-12-12
1437795747 Brigitte Britt Huttemeyer Nurse Practitioner 678 Castle Pinckney Dr, Charleston, SC 29412 2019-11-21
1124660774 Dennis Robert Moore Nurse Practitioner 4610 Kanawha Ave Sw Ste 302, Charleston, WV 25309-1367 2019-10-16
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Competitor

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City CHARLESTON
Zip Code 25301

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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