Individual
SHANNON L TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
3009 N BALLAS RD, STE 264C, SAINT LOUIS, MO 63131-2322
(314) 996-7940
(314) 996-7945
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(314) 996-7940
(314) 996-7945
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2006019382
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
2014036832
MO
Other
Enumeration date
10/09/2014
Last updated
03/22/2021
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