Fredrick Jason Tackett, APS004051 is a
Peer Specialist based in Coal Grove, Ohio. Fredrick Jason Tackett is licensed to practice in * (Not Available) (license number ) and his current practice location is
323 Marion Pike Ste 1, Coal Grove, Ohio. He can be reached at his office (for appointments etc.) via phone at
(740) 237-4981.
NPI number for Fredrick Jason Tackett is 1235820051 and his current mailing address is 117 N 4th St, Ironton, Ohio. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1235820051.
Healthcare Provider's Profile
| Full Name | Fredrick Jason Tackett |
|---|
| Gender | Male |
|---|
| Speciality | Peer Specialist |
|---|
| Location | 323 Marion Pike Ste 1, Coal Grove, Ohio |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1235820051
- Provider Enumeration Date: 05/15/2023
- Last Update Date: 06/12/2023
Medical Identifiers
Medical identifiers for Fredrick Jason Tackett such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1235820051 | NPI | - | NPPES |
| 0017298 | Medicaid | OH | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 171M00000X | Case Manager/care Coordinator | (* (Not Available)) | Secondary |
| 175T00000X | Peer Specialist | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Fredrick Jason Tackett is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Fredrick Jason Tackett, APS004051
117 N 4th St,
Ironton, OH 45638-1403
Ph: (740) 442-7016 | Fredrick Jason Tackett, APS004051
323 Marion Pike Ste 1,
Coal Grove, OH 45638-2958
Ph: (740) 237-4981 |
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