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General NPI Number Information
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NPI Number | 1659365427
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Entity Type | Individual
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Provider Name | TAMMY JEAN HALE TUCKER D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 2905 S WALTON BLVD STE 17
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City | BENTONVILLE
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State | AR
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Zip | 72712-6730
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Country | US
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Telephone | 479-657-6800
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Fax | 479-268-4272
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Provider Business Mailing Address
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Address Line | 103 SOMERSET
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City | BENTONVILLE
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State | AR
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Zip | 72712-4091
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Country | US
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Telephone | 870-405-8579
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E3741
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License Number State | AR
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