Healthcare Provider Details

I. General information

NPI: 1114853876
Provider Name (Legal Business Name): KESHIA TUCKER MA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 HEYWARD ST
CINCINNATI OH
45205-1011
US

IV. Provider business mailing address

4007 HEYWARD ST
CINCINNATI OH
45205-1011
US

V. Phone/Fax

Practice location:
  • Phone: 513-413-1886
  • Fax:
Mailing address:
  • Phone: 513-413-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberOH18468E1106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: