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

Mr. Ellis Ray Tackett III, ATCLAT

Individual provider Specialist · NPI 1821489576

Mr. Ellis Ray Tackett III, ATCLAT is a Specialist in Pikeville, Kentucky. Licensed in Kentucky. Registered with an NPI since 2015.

Licensed in
KY
In the registry since
2015

Practice location Address checks out

147 Sycamore St
Pikeville, KY 41501-9118
Phone: (606) 213-1620
Fax: (606) 218-5353
Show map & directions

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

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence AT1092 (KY)

Record details

NPI number1821489576
Entity typeIndividual (Type 1)
GenderMale
Credentials ATCLAT
Sole proprietorNo
NPI enumeratedFebruary 16, 2015
Last updated in NPPESFebruary 16, 2015

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