MEDICARE: ANDRINEE WILSON-TUCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY27585	CA

General Provider Information

NPI Number	:	1417296211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRINEE WILSON-TUCKER

Provider Business Mailing Address
First Line	:	6569 N RIVERSIDE DR STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-9319
Country	:	US
Telephone Number	:	404-441-9841
Fax Number	:

Provider Business Practice Location Address
First Line	:	6569 N RIVERSIDE DR STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-9319
Country	:	US
Telephone Number	:	404-441-9841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2013
Last Update Date	:	01/29/2026

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