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General NPI Number Information
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NPI Number | 1033301205
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Entity Type | Organization
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Legal Business Name | LETICIA K. TUCKER, M.D., L.L.C.
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 1215 OLD MAIN ST
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City | HARTFORD
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State | KY
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Zip | 42347-1619
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Country | US
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Telephone | 270-298-5164
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Fax | 270-298-5285
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Provider Business Mailing Address
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Address Line | 1215 OLD MAIN ST
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City | HARTFORD
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State | KY
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Zip | 42347-1619
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Country | US
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Telephone | 270-298-5164
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Fax | 270-298-5285
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Authorized Official
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Title or Position | DR.
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Name | LETICIA TUCKER
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Credential |
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Telephone | 270-298-5164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37109
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License Number State | KY
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