Individual provider · Type 1 NPI
Benjamin Tackett, FNP
Family Nurse Practitioner · Logan, WV
NPI number
1265959704
Active
Practice location
140 Stollings Ave Ste 1
Logan, WV 25601-4035
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 66717 (WV) |
Family Nurse Practitioner: Definition to come...
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About NPI 1265959704
Benjamin Tackett, FNP's National Provider Identifier is 1265959704, issued on Aug 25, 2017. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Logan, WV. The record was last updated on Aug 25, 2017.