Healthcare Provider Details

I. General information

NPI: 1346463205
Provider Name (Legal Business Name): REBECCA SUZANNA KING-TUCKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA SUZANNA KING M.D.

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 N MERRITT CREEK LOOP STE A
COEUR D ALENE ID
83814-4961
US

IV. Provider business mailing address

110 W HONEY CREEK PKWY
TERRE HAUTE IN
47802-4114
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-2183
  • Fax:
Mailing address:
  • Phone: 812-232-2890
  • Fax: 317-988-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number01077239A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number3081324
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: