Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mary Tackbary

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1588282784

Mary Tackbary is a Certified Clinical Nurse Specialist (Cns) in Traverse City, Michigan. Qualified in 2022, 4 years ago. Practices as a sole proprietor. Licensed in Michigan.

Years since qualifying
4
Licensed in
MI
In the registry since
2020

Practice location Address checks out

928 S Garfield Ave Ste 3A
Traverse City, MI 49686-2403
Phone: (231) 835-0115
Fax: (231) 216-7641
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 4704106451 (MI)

Record details

NPI number1588282784
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 14, 2020
Last updated in NPPESFebruary 20, 2025
Certification dateFebruary 20, 2025
Mailing address3932 W Briar Hill Dr, Maple City, MI 49664-9521

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED CLINICAL NURSE SPECIALIST (CNS)
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Traverse City