Individual
MARY W TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Contact information
Practice address
116 CHANTILLY LANE, MARYVILLE, TN 37803
(865) 273-1616
(865) 273-1645
Mailing address
PO BOX 5629, MARYVILLE, TN 37802-5629
(865) 273-1752
(865) 273-1755
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
APN0000010443
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3341063
—
TN
01
—
APN0000010443
LICENSE
TN
Enumeration date
03/08/2007
Last updated
02/19/2008
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