MEDICARE: DESHAUNA RENA TUCKER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	7663	OK
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1093392326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESHAUNA RENA TUCKER DO

Provider Business Mailing Address
First Line	:	3300 NW EXPRESSWAY ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 NW EXPRESSWAY ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4418
Country	:	US
Telephone Number	:	405-949-3011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	05/26/2026

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