Healthcare Provider Details

I. General information

NPI: 1790510832
Provider Name (Legal Business Name): TUCKER JACOB MCKINNEY DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 WALLACE RD STE 206
NASHVILLE TN
37211-4854
US

IV. Provider business mailing address

397 WALLACE RD STE 206
NASHVILLE TN
37211-4854
US

V. Phone/Fax

Practice location:
  • Phone: 832-869-4818
  • Fax:
Mailing address:
  • Phone: 832-869-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number42547
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: