Individual
MARY KNUTH TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
1405 WILLOW LN, SUITE A, NORTH WILKESBORO, NC 28659-3551
(336) 667-0335
(336) 667-4434
Mailing address
1405 WILLOW LN, SUITE A, NORTH WILKESBORO, NC 28659-3551
(336) 667-0335
(336) 667-4434
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200814
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0481610001
DMERC/PGBA
SC
01
—
0575
MEDICARE GROUP
NC
05
—
8902938
—
NC
Enumeration date
10/14/2005
Last updated
12/11/2013
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