MEDICARE: MORGAN 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
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1760217988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN TUCKER

Provider Business Mailing Address
First Line	:	1409 RANKIN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-2235
Country	:	US
Telephone Number	:	314-337-3606
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 OVERLAND TRL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-1838
Country	:	US
Telephone Number	:	937-272-2023
Fax Number	:

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

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/06/2024

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Directions to “ MORGAN TUCKER ” Practice Location

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