Individual
MARK A TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
650 HIGH ST, DANVILLE, KY 40422-1235
(859) 253-1686
(859) 254-2743
Mailing address
1351 NEWTOWN PIKE, LEXINGTON, KY 40511-1217
(859) 253-1686
(859) 254-2743
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
3334
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30615058
—
KY
Enumeration date
11/13/2007
Last updated
11/13/2007
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