MEDICARE: VERNON O TUCKER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	C000969	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5T077	OTHER	AR	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417937657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNON O TUCKER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 583
Second Line	:
City	:	LOWELL
State	:	AR
Zip	:	72745-0583
Country	:	US
Telephone Number	:	888-991-1101
Fax Number	:	903-787-5854

Provider Business Practice Location Address
First Line	:	3728 S PINNACLE HILLS PKWY
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8897
Country	:	US
Telephone Number	:	479-790-3328
Fax Number	:

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

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	02/07/2023

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Directions to “ VERNON O TUCKER CRNA” Practice Location

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