MEDICARE: VANESSA LYNN TUCKER APRN

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	163WS0200X	School Registered Nurse	1099916	KY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3017881	KY

General Provider Information

NPI Number	:	1861551400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA LYNN TUCKER APRN

Provider Business Mailing Address
First Line	:	4913 MARIAN CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1448
Country	:	US
Telephone Number	:	859-296-1167
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 ROSE ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-1113
Country	:	US
Telephone Number	:	859-257-1000
Fax Number	:	859-323-1194

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	06/17/2022

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