Individual
VERNON O TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3728 S PINNACLE HILLS PKWY, ROGERS, AR 72758-8897
(479) 790-3328
Mailing address
PO BOX 583, LOWELL, AR 72745-0583
(888) 991-1101
(903) 787-5854
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C000969
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134260701
—
AR
01
—
5T077
BCBS
AR
05
—
917321903
—
MO
Enumeration date
01/21/2006
Last updated
02/07/2023
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