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General NPI Number Information
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NPI Number | 1386901486
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Entity Type | Individual
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Provider Name | BECKY CONLEY TUCKER NP
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Gender | Female
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 1004 COMMUNITY RD
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City | GLENNVILLE
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State | GA
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Zip | 30427-7711
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Country | US
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Telephone | 912-654-9170
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Fax | 337-262-9736
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Provider Business Mailing Address
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Address Line | 1004 COMMUNITY RD
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City | GLENNVILLE
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State | GA
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Zip | 30427-7711
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Country | US
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Telephone | 912-654-9170
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Fax | 337-262-9736
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN137050
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License Number State | GA
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