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General NPI Number Information
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NPI Number | 1467988600
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Entity Type | Organization
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Legal Business Name | KINDRELL S. TUCKER, MD, PA
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Dates
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Enumeration Date | 05/09/2017
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 305 SHANDS DR
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City | LUFKIN
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State | TX
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Zip | 75904-2885
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Country | US
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Telephone | 936-225-3657
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Fax | 936-899-7293
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Provider Business Mailing Address
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Address Line | PO BOX 154137
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City | LUFKIN
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State | TX
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Zip | 75915-4137
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Country | US
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Telephone | 936-225-3657
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Fax | 936-899-7293
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Authorized Official
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Title or Position | OWNER
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Name | KINDRELL S TUCKER
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Credential | M.D.
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Telephone | 936-225-3657
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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 | Q3822
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License Number State | TX
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