=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487543328
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY HIGDON TUCKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2025
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 148 W CHURCH ST STE B
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38351-2069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-798-5047
-----------------------------------------------------
Fax | 731-798-5079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 FLAGSTONE DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38305-8581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-394-3735
-----------------------------------------------------
Fax | 731-394-3735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 6140
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------