Provider Demographics
NPI:1033980032
Name:TUCK, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:TUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 WAVE AVE
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2821
Mailing Address - Country:US
Mailing Address - Phone:805-748-9677
Mailing Address - Fax:
Practice Address - Street 1:133 WAVE AVE
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2821
Practice Address - Country:US
Practice Address - Phone:805-748-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula