Provider Demographics
NPI:1407173446
Name:TUCKER, DANA (APRN)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:APRN
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 550
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0550
Mailing Address - Country:US
Mailing Address - Phone:606-796-3029
Mailing Address - Fax:606-796-6221
Practice Address - Street 1:1551 AUGUSTA CHATHAM RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KY
Practice Address - Zip Code:41002-9224
Practice Address - Country:US
Practice Address - Phone:606-756-2117
Practice Address - Fax:606-756-2135
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006436363LW0102X
KY6436P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100113900Medicaid
OH3050577Medicaid
KY7100113900Medicaid