Basic Information
| Provider Information | |||||||||
| NPI: | 1609279546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TACKETT | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7527 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432070527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147886010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 OHIOHEALTH BLVD | ||||||||
| Address2: | STE 180 | ||||||||
| City: | DELAWARE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406150227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2014 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN.CNP.15888 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | COA.15888-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.