Provider Demographics
NPI:1033513577
Name:TUCKER, JESSE (RN, MSN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:RN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N BOWEN RD STE 126
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2800
Mailing Address - Country:US
Mailing Address - Phone:817-478-5333
Mailing Address - Fax:
Practice Address - Street 1:1006 N BOWEN RD STE 126
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2800
Practice Address - Country:US
Practice Address - Phone:817-478-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126798363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health