Provider Demographics
NPI:1023409844
Name:TUCKER, DANIELLE (NP)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:WATTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 650
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3279
Mailing Address - Country:US
Mailing Address - Phone:816-559-6531
Mailing Address - Fax:
Practice Address - Street 1:8250 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1103
Practice Address - Country:US
Practice Address - Phone:816-459-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77120-051363LF0000X
MO2014044285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily