Provider Demographics
NPI:1164988820
Name:TUCK-CHAPPILL, JENNIFER KAREN (MD, LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAREN
Last Name:TUCK-CHAPPILL
Suffix:
Gender:F
Credentials:MD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-691-8070
Mailing Address - Fax:270-691-8026
Practice Address - Street 1:1000 BRECKENRIDGE ST STE 401
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0878
Practice Address - Country:US
Practice Address - Phone:270-688-4401
Practice Address - Fax:270-688-4409
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 104100000X
KY57471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker