1881184067 NPI number — JUDITH LYNN CORRADO TUCKER APRN

Table of content: JUDITH LYNN CORRADO TUCKER APRN (NPI 1881184067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881184067 NPI number — JUDITH LYNN CORRADO TUCKER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUCKER
Provider First Name:
JUDITH
Provider Middle Name:
LYNN CORRADO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORRADO
Provider Other First Name:
JUDITH
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881184067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 REMINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARDSTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40004-2268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-240-2985
Provider Business Mailing Address Fax Number:
513-938-8180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 CAROTHERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41071-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-240-2985
Provider Business Practice Location Address Fax Number:
513-938-8180
Provider Enumeration Date:
05/14/2018

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: 363L00000X , with the licence number:  3012260 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: APRN.CNP.022476 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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