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NPI Code Detail

MEDICARE: KERRY A TUCKER PMHNP-BC

MEDICARE: KERRY A TUCKER PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner106714WV

General Provider Information

NPI Number : 1699383414
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY A TUCKER PMHNP-BC
Provider Business Mailing Address
First Line : PO BOX 192
Second Line :
City : SHEPHERDSTOWN
State : WV
Zip : 25443-0192
Country : US
Telephone Number : 304-876-3500
Fax Number : 304-254-6970
Provider Business Practice Location Address
First Line : 4781 KEARNEYSVILLE PIKE
Second Line :
City : SHEPHERDSTOWN
State : WV
Zip : 25443-4666
Country : US
Telephone Number : 304-876-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2020
Last Update Date : 07/11/2025

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