Healthcare Provider Details

I. General information

NPI: 1629983507
Provider Name (Legal Business Name): MR. TUCKER JOHN EVERETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 DELAWARE AVENUE
PALMERTON PA
18071
US

IV. Provider business mailing address

3444 FURY CT
SLATINGTON PA
18080-1023
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6545
  • Fax:
Mailing address:
  • Phone: 484-735-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: