Provider Demographics
NPI:1871201285
Name:TACKETT, MACY MARIE (MSN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MACY
Middle Name:MARIE
Last Name:TACKETT
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:MS
Other - First Name:MACY
Other - Middle Name:MARIE
Other - Last Name:TACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6063 S MYERS RD
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9441
Mailing Address - Country:US
Mailing Address - Phone:330-936-7653
Mailing Address - Fax:
Practice Address - Street 1:3094 W MARKET ST STE 360
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3618
Practice Address - Country:US
Practice Address - Phone:614-987-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.453033163WA0400X
OHAPRN.CNP.0035112363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)