# KYLE DAVID TUCKER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1104706365
- **Gender:** Man
- **Credential:** RN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WE0003X | Emergency Registered Nurse | 95255871 | CA | — |
| 363L00000X | Nurse Practitioner | 95039691 | CA | Yes |
| 363LF0000X | Family Nurse Practitioner | 95039691 | CA | — |

## Other

- **Enumeration date:** 09/06/2025
- **Last updated:** 08/13/2026