Healthcare Provider Details

I. General information

NPI: 1457003808
Provider Name (Legal Business Name): KERRY TUCKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. ARMY HEALTH CLINIC UNIT 30455 PATCH BARRACKS
APO AE
09154
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2900
  • Fax:
Mailing address:
  • Phone: 757-953-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95269829
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95269829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: