Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25MA09920700 | NJ |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA09920700 | NJ |
NPI | 1023308988 |
---|---|
Provider Name | Dr. Kimberly Victoria Tucker |
First Address | Boston, MA 02241-6457 |
Second Address | Bridgewater, NJ 08807-1746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2011 |
Last Update Date | 29/12/2020 |