Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 104137 | MO |
NPI | 1083826762 |
---|---|
Provider Name | Teresa Lyn Tucker |
First Address | Kirksville, MO 63501-4200 |
Second Address | Kirksville, MO 63501-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 02/03/2021 |