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NPI Code Detail

MEDICARE: AMY MICHELLE TUCKER

MEDICARE: AMY MICHELLE TUCKER
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1568943868
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MICHELLE TUCKER
Provider Business Mailing Address
First Line : PO BOX 12978
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73157-2978
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 224 NW 10TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73103-3902
Country : US
Telephone Number : 580-695-1550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2018
Last Update Date : 08/24/2018

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Directions to “ AMY MICHELLE TUCKER ” Practice Location

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