Provider Demographics
NPI:1255504692
Name:TUCKER, KIMBERLY MCKERLEY (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MCKERLEY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1106
Mailing Address - Country:US
Mailing Address - Phone:256-492-7800
Mailing Address - Fax:256-494-5536
Practice Address - Street 1:901 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1106
Practice Address - Country:US
Practice Address - Phone:256-492-7800
Practice Address - Fax:256-494-5536
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3453B101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health