Provider Demographics
NPI:1326067992
Name:TUCKER, HEATHER MARIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 KINGS DAUGHTERS DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6561
Mailing Address - Country:US
Mailing Address - Phone:502-226-7872
Mailing Address - Fax:
Practice Address - Street 1:12201 BLUEGRASS PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2361
Practice Address - Country:US
Practice Address - Phone:502-568-7364
Practice Address - Fax:502-568-7136
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2672P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS81667Medicare UPIN