Healthcare Provider Details

I. General information

NPI: 1932568482
Provider Name (Legal Business Name): KATHERINE A TUCKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N 4TH ST
TERRE HAUTE IN
47804-4002
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-3600
  • Fax: 812-242-3620
Mailing address:
  • Phone: 812-232-0564
  • Fax: 812-242-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006076A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: