Doctor Name: | TERESA L TUCKER |
NPI Number: | 1083826762 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, WHNP |
License Number: | 104137 |
Business Practice Address: | 2306 North Somerset Lane Kirksville, MO - 63501 |
Business Phone Number: | 6606650619 |
Business Fax Number: | |
Mailing Address: | 2306 North Somerset Lane, KIRKSVILLE |
State: | MO |
Postal Code: | 63501 |
Phone Number: | 6606650619 |
Fax Number: | |
NPI Enumeration Date: | 05/04/2007 |
NPI Last Update Date: | 11/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 104137 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |