Healthcare Provider Details

I. General information

NPI: 1679346910
Provider Name (Legal Business Name): HEATHER TUCK CPED CFOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N MAIN ST
HARRISON AR
72601-2212
US

IV. Provider business mailing address

651 SALEM RD
BRANSON MO
65616-7304
US

V. Phone/Fax

Practice location:
  • Phone: 417-619-0109
  • Fax:
Mailing address:
  • Phone: 417-619-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: