Individual
JESSE RAYMOND TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 TILGHMAN DR, DUNN, NC 28334-5510
(910) 892-1000
(910) 891-6032
Mailing address
306 VILLAGE SQUARE DR, DUNN, NC 28334-2850
(910) 892-7664
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
031777
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
062995
NC BOARD OF NURSING VERIF
NC
Enumeration date
09/02/2006
Last updated
07/08/2007
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