| Doctor Name: | MR. JESSE TUCKER |
| NPI Number: | 1033513577 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN, MSN, PMHNP-BC |
| License Number: | AP126798 |
| Business Practice Address: | 2219 W Euless Blvd Euless, TX - 760406624 |
| Business Phone Number: | 8178579109 |
| Business Fax Number: | |
| Mailing Address: | 2219 W Euless Blvd, EULESS |
| State: | TX |
| Postal Code: | 760406624 |
| Phone Number: | 8178579109 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2014 |
| NPI Last Update Date: | 12/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | AP126798 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |