Provider Demographics
NPI:1083362727
Name:TUCKER, BRITNEY S
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:S
Last Name:TUCKER
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 1:306 E BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2101
Mailing Address - Country:US
Mailing Address - Phone:940-389-2713
Mailing Address - Fax:
Practice Address - Street 1:306 E BRENTWOOD ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2101
Practice Address - Country:US
Practice Address - Phone:940-389-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTRC020010832278G0305X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G0305XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeriatric Care