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General NPI Number Information
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NPI Number | 1215596036
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Entity Type | Individual
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Provider Name | MCKENZIE B TUCKER DO
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Gender | Female
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 1413 N ELM ST STE 201
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City | HENDERSON
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State | KY
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Zip | 42420-2767
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Country | US
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Telephone | 270-827-8662
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Fax | 270-826-8220
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Provider Business Mailing Address
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Address Line | PO BOX 1510
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City | EVANSVILLE
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State | IN
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Zip | 47706-1510
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Country | US
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Telephone | 812-450-6815
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Fax | 812-450-6822
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11020485A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05137
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License Number State | KY
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