Individual
MARY WALL TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
317 N KING ST STE B, HENDERSONVILLE, NC 28792-4349
(828) 693-9199
(828) 692-2487
Mailing address
PO BOX 360, SYLVA, NC 28779-0360
(888) 339-6065
(828) 538-4441
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
72955
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154W2
BCBS NC(LFM)
NC
05
—
1881748440
—
NC
01
—
NC4942C
MEDICARE PTAN(LFM)
NC
01
—
P02130832
RAILROAD MEDICARE PTAN(LFM)
NC
Enumeration date
01/22/2007
Last updated
11/12/2019
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