MEDICARE: DR. ANN TUCKER PH D

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	103TC0700X	Clinical Psychologist	20456 WITN HSP	TX

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

General Provider Information

NPI Number	:	1467463182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN TUCKER PH D

Provider Business Mailing Address
First Line	:	7055 RICHLYNN TERRACE
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-5119
Country	:	US
Telephone Number	:	817-595-1177
Fax Number	:	817-595-1177

Provider Business Practice Location Address
First Line	:	7055 RICHLYNN TERRACE
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-5119
Country	:	US
Telephone Number	:	817-595-1177
Fax Number	:	817-595-1177

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	11/04/2010

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