Provider Demographics
NPI:1033605514
Name:TUCKER, TRACY L (FNP-BC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:TUCKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:WYRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 KEITH ST
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2007
Mailing Address - Country:US
Mailing Address - Phone:573-259-1053
Mailing Address - Fax:
Practice Address - Street 1:418 CRANE ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-1906
Practice Address - Country:US
Practice Address - Phone:573-259-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-07
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018024153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily