Healthcare Provider Details

I. General information

NPI: 1285538736
Provider Name (Legal Business Name): KASEY ELIZABETH TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S NEDDERMAN DR
ARLINGTON TX
76019-9800
US

IV. Provider business mailing address

1746 ESCADA
SAN ANTONIO TX
78258-4532
US

V. Phone/Fax

Practice location:
  • Phone: 817-272-2090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1121896
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: