Healthcare Provider Details

I. General information

NPI: 1770092058
Provider Name (Legal Business Name): TERRY LEE TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRY LEE GREGORY

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 W 5TH AVE
KNOXVILLE TN
37917-7109
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-2104
  • Fax: 865-252-1212
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number75738
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: