MEDICARE: DR. KELSEE MARIE TUCKER PH.D.

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	103T00000X	Psychologist	20043742B	IN

General Provider Information

NPI Number	:	1992378434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSEE MARIE TUCKER PH.D.

Provider Business Mailing Address
First Line	:	7230 ARBUCKLE CMNS
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-1791
Country	:	US
Telephone Number	:	614-257-5393
Fax Number	:

Provider Business Practice Location Address
First Line	:	7230 ARBUCKLE CMNS
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-1791
Country	:	US
Telephone Number	:	614-257-5393
Fax Number	:

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

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	03/10/2026

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