1609319136 NPI number — MRS. KARA EARTHMAN TUCKER

Table of content: MRS. KARA EARTHMAN TUCKER (NPI 1609319136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609319136 NPI number — MRS. KARA EARTHMAN TUCKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUCKER
Provider First Name:
KARA
Provider Middle Name:
EARTHMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609319136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3024 BUSINESS PARK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODLETTSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37072-3132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-851-6033
Provider Business Mailing Address Fax Number:
615-851-2018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 NEW SHACKLE ISLAND RD
Provider Second Line Business Practice Location Address:
SUITE 221B
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-822-3880
Provider Business Practice Location Address Fax Number:
615-264-1664
Provider Enumeration Date:
12/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  22061 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q026121 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6091937 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com