Individual
LAUREN K TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5260
(601) 984-2652
Mailing address
504 CLINTON CENTER DR STE 4300, CLINTON, MS 39056-5610
(601) 496-9794
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
23804
MS
208000000X
Pediatrics Physician
T-2613
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03320306
—
MS
Enumeration date
06/29/2012
Last updated
02/15/2021
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