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General NPI Number Information
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NPI Number | 1295672491
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Entity Type | Individual
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Provider Name | KALISTA SHEA TUCKER
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Gender | Female
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 232 BOONE HEIGHTS DR # A
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City | BOONE
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State | NC
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Zip | 28607-4926
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Country | US
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Telephone | 828-386-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 180 ADAMS LN
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City | BOONE
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State | NC
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Zip | 28607-7757
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Country | US
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Telephone | 980-622-6137
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NC
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