MARY TACKBARY NPI 1588282784

NPI Information

  • NPI: 1588282784
  • Provider Name: MARY TACKBARY
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 928 S GARFIELD AVE STE 3A
    TRAVERSE CITY, MI
    ZIP 49686
  • Phone: (231) 835-0115

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NPI Details

Mary Tackbary is a psychiatric/mental health nurse practitioner in Traverse City, MI. Mary Tackbary NPI is 1588282784. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

928 S GARFIELD AVE STE 3A
TRAVERSE CITY, MI
ZIP 49686-403
Phone: (231) 835-0115
Fax: (231) 216-7641

The NPI 1588282784 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 7/14/2020 and was last updated on 2/20/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0808XNurse PractitionerPsychiatric/Mental Health4704106451MICHIGANYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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