Provider Demographics
NPI:1831777630
Name:TACKETT, KELLY JO NICOLE (MD MPH)
Entity type:Individual
Prefix:DR
First Name:KELLY JO
Middle Name:NICOLE
Last Name:TACKETT
Suffix:
Gender:F
Credentials:MD MPH
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Mailing Address - Street 1:PO BOX 90003
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28290-0003
Mailing Address - Country:US
Mailing Address - Phone:828-845-8099
Mailing Address - Fax:
Practice Address - Street 1:1119 HENDERSONVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-6622
Practice Address - Country:US
Practice Address - Phone:828-274-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2025-01841207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology