Provider Demographics
NPI:1376176784
Name:TUCKER, KELCY (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KELCY
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:KELCY
Other - Middle Name:
Other - Last Name:HARTBARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:3165 DAYTON XENIA RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6309
Mailing Address - Country:US
Mailing Address - Phone:419-494-2715
Mailing Address - Fax:
Practice Address - Street 1:3165 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6309
Practice Address - Country:US
Practice Address - Phone:419-494-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily