Individual
JESSICA TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1336 N HARRISON AVE, SHAWNEE, OK 74801-5206
(405) 424-7711
Mailing address
43275 PRAIRIE RANCH RD, SHAWNEE, OK 74804-2654
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0071475
OK
Other
Enumeration date
04/04/2024
Last updated
04/04/2024
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