Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 23804 | MS |
N | 208000000X | Pediatrician | T-2613 | MS |
NPI | 1003170481 |
---|---|
Provider Name | Lauren K Tucker |
First Address | Clinton, MS 39056-5610 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03320306 | (05) | MS |