Provider Demographics
NPI:1154466456
Name:TUCKER, OPHELIA D
Entity Type:Individual
Prefix:MRS
First Name:OPHELIA
Middle Name:D
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 1:638 TOY DENNY RD
Mailing Address - Street 2:
Mailing Address - City:BRADYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37026-5101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:TN DEPT OF HEALTH
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1100
Practice Address - Country:US
Practice Address - Phone:615-563-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide