MEDICARE: MRS. MARLA LYNN TUCKER NP

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	363LF0000X	Family Nurse Practitioner	113908	NE
2	363LF0000X	Family Nurse Practitioner	75019	KS
3	363LF0000X	Family Nurse Practitioner	2010000564	MO

General Provider Information

NPI Number	:	1881928703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARLA LYNN TUCKER NP

Provider Business Mailing Address
First Line	:	5409 N WYOMING ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-3102
Country	:	US
Telephone Number	:	816-808-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	17067 S OUTER RD STE 100
Second Line	:
City	:	BELTON
State	:	MO
Zip	:	64012-2100
Country	:	US
Telephone Number	:	816-331-4000
Fax Number	:

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

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	10/17/2024

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