Individual
MRS. MARY KAY TUCKER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN BSN MPH CPNP
Contact information
Practice address
8 MEDICAL PARK DR, LEXINGTON, NC 27292-6768
(336) 249-4911
(336) 249-1782
Mailing address
211 IVYSTONE CT, WINSTON SALEM, NC 27104-5050
(336) 659-0558
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
73417
NC
Other
Enumeration date
11/28/2005
Last updated
07/08/2007
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