Healthcare Provider Details

I. General information

NPI: 1881501625
Provider Name (Legal Business Name): JACK ARTHUR TUCKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 SOUTHPARK LN UNIT 100
LITTLETON CO
80120-4502
US

IV. Provider business mailing address

2405 PALMER CIR STE 100
NORMAN OK
73069-6351
US

V. Phone/Fax

Practice location:
  • Phone: 720-617-1581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: