Provider Demographics
NPI:1235363714
Name:KATHLEEN FRASER TUCKER
Entity Type:Organization
Organization Name:KATHLEEN FRASER TUCKER
Other - Org Name:MIDDLEBURG ACUPUNCTURE & APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPL AC
Authorized Official - Phone:703-232-2025
Mailing Address - Street 1:PO BOX 1934
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1934
Mailing Address - Country:US
Mailing Address - Phone:703-232-2025
Mailing Address - Fax:
Practice Address - Street 1:112 W WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:VA
Practice Address - Zip Code:20117-2698
Practice Address - Country:US
Practice Address - Phone:703-232-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000451171100000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty