Provider Demographics
NPI:1326687898
Name:TUCKER-BLAND, SCOTTY D (LVN)
Entity Type:Individual
Prefix:MR
First Name:SCOTTY
Middle Name:D
Last Name:TUCKER-BLAND
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 SPRING ROSE CIR APT C
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-8833
Mailing Address - Country:US
Mailing Address - Phone:832-207-5536
Mailing Address - Fax:
Practice Address - Street 1:1706 SPRING ROSE CIR APT C
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-8833
Practice Address - Country:US
Practice Address - Phone:832-207-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193081164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse