Tackett, Jason Preston

Tackett, Jason Preston is an individual health care provider with primary practice located at 3500 Franciscan Way , Michigan City IN 46360-0021. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Tackett, Jason Preston can be contacted via phone (219) 879-8511.

Contact Information

Primary practice address
3500 Franciscan Way Michigan City IN 46360-0021
Phone: (219) 879-8511
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 28164172A Indiana
Nursing Service Providers / Registered Nurse 163W00000X 041188540 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209012575 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 71003469A Indiana

Profile Details

NPI number 1821304296
LBN Legal business name Tackett, Jason Preston
Credentials NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2010
Last updated Sep 13th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821304296 NPPES
Indiana MEDICAID 201012930

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