Healthcare Provider Details

I. General information

NPI: 1336208750
Provider Name (Legal Business Name): KAREN TUCKER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 HAWKINS DR.
SEARCY AR
72143
US

IV. Provider business mailing address

2918 HAWKINS DR.
SEARCY AR
72143
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-9255
  • Fax: 501-279-9257
Mailing address:
  • Phone: 501-279-9255
  • Fax: 501-279-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1616
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: