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General NPI Number Information
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NPI Number | 1033605514
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Entity Type | Individual
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Provider Name | TRACY L TUCKER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/07/2018
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 418 CRANE ST
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City | PARK HILLS
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State | MO
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Zip | 63601-1906
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Country | US
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Telephone | 573-259-1053
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Fax |
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Provider Business Mailing Address
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Address Line | 407 KEITH ST
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City | PARK HILLS
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State | MO
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Zip | 63601-2007
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Country | US
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Telephone | 573-259-1053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2018024153
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License Number State | MO
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