Healthcare Provider Details

I. General information

NPI: 1023926755
Provider Name (Legal Business Name): CHRISTIAN TUCKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 E MAIN ST
COLUMBUS OH
43213-2410
US

IV. Provider business mailing address

4949 CROSSCREEK DR
COLUMBUS OH
43232-6192
US

V. Phone/Fax

Practice location:
  • Phone: 614-620-9392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: