Provider Demographics
NPI:1316040850
Name:TUCKER, ROBERT L (FNP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:TUCKER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:WEBB
Mailing Address - State:MS
Mailing Address - Zip Code:38966-0627
Mailing Address - Country:US
Mailing Address - Phone:662-375-9310
Mailing Address - Fax:662-375-9311
Practice Address - Street 1:2372 HWY 49 EAST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:MS
Practice Address - Zip Code:38957-0250
Practice Address - Country:US
Practice Address - Phone:662-375-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
224548OtherHEALTH PARTNERS CLAIMS
MS00123085Medicaid
MS253408OtherMEDICARE PART A
MS253408OtherMEDICARE PART A