Healthcare Provider Details

I. General information

NPI: 1902190671
Provider Name (Legal Business Name): LAUREN WILLIAMS TUCKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN HALEY WILLIAMS

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304B CHARLES T WETHINGTON BLDG
LEXINGTON KY
40536-0200
US

IV. Provider business mailing address

304B CHARLES T WETHINGTON BLDG
LEXINGTON KY
40536-0200
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-9918
  • Fax: 859-323-1197
Mailing address:
  • Phone: 859-323-9918
  • Fax: 859-323-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR2659
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: