Individual
BRONYA KAY TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1325 LOCUST AVE, FAIRMONT, WV 26554-1435
(304) 367-7100
Mailing address
PO BOX 1615, MORGANTOWN, WV 26507-1615
(304) 285-3679
(304) 285-3694
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
50676
WV
363LF0000X
Family Nurse Practitioner
50676
WV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
50676
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50676
LICENSE
WV
Enumeration date
04/02/2009
Last updated
11/18/2020
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