Provider Demographics
NPI:1205863412
Name:TUCKER, WILLIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2754
Mailing Address - Country:US
Mailing Address - Phone:865-632-5885
Mailing Address - Fax:
Practice Address - Street 1:6600 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2754
Practice Address - Country:US
Practice Address - Phone:865-632-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCA7018OtherRAILROAD MEDICARE
TN3661653Medicaid
TN1508714Medicaid
TNP86943Medicare UPIN