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General NPI Number Information
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NPI Number | 1629983507
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Entity Type | Individual
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Provider Name | MR. TUCKER JOHN EVERETT
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Gender | Male
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 614 DELAWARE AVENUE
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City | PALMERTON
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State | PA
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Zip | 18071
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Country | US
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Telephone | 484-526-6545
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Fax |
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Provider Business Mailing Address
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Address Line | 3444 FURY CT
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City | SLATINGTON
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State | PA
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Zip | 18080-1023
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Country | US
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Telephone | 484-735-0353
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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 | PA
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