Healthcare Provider Details

I. General information

NPI: 1346943743
Provider Name (Legal Business Name): NATASHA NICOLE TUCKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 S 4TH ST
LEAVENWORTH KS
66048-5071
US

IV. Provider business mailing address

9113 ALLMAN RD
LENEXA KS
66219-1175
US

V. Phone/Fax

Practice location:
  • Phone: 913-680-6100
  • Fax:
Mailing address:
  • Phone: 913-832-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023026066
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023026066
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82060-031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: