Healthcare Provider Details

I. General information

NPI: 1881928703
Provider Name (Legal Business Name): MARLA LYNN TUCKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17067 S OUTER RD STE 100
BELTON MO
64012-2100
US

IV. Provider business mailing address

5409 N WYOMING ST
KANSAS CITY MO
64118-3102
US

V. Phone/Fax

Practice location:
  • Phone: 816-331-4000
  • Fax:
Mailing address:
  • Phone: 816-808-8338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113908
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75019
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010000564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: