Individual
KELLYN TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1534 BISHOP RD SW, TUMWATER, WA 98512-7354
(360) 357-2370
Mailing address
6961 FLUTE ST SE, LACEY, WA 98513-5052
(360) 508-5221
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/27/2023
Last updated
08/03/2023
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