Doctor Name: | SHONDA LYNN TUCKER |
NPI Number: | 1528436334 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 3009676 |
Business Practice Address: | 188 Hospital Ln Jellico, TN - 377624400 |
Business Phone Number: | 4237847272 |
Business Fax Number: | 4237841136 |
Mailing Address: | 188 Hospital Ln, JELLICO |
State: | TN |
Postal Code: | 377624400 |
Phone Number: | 4237847272 |
Fax Number: | 4237841136 |
NPI Enumeration Date: | 09/10/2015 |
NPI Last Update Date: | 09/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 3009676 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |